Provider Demographics
NPI:1467119354
Name:GOLDEN GATE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:GOLDEN GATE PHARMACY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:415-455-9042
Mailing Address - Street 1:8 DIGITAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-8705
Mailing Address - Country:US
Mailing Address - Phone:415-455-9042
Mailing Address - Fax:415-455-9318
Practice Address - Street 1:8 DIGITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-8705
Practice Address - Country:US
Practice Address - Phone:415-455-9042
Practice Address - Fax:415-455-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA407420Medicaid