Provider Demographics
NPI:1477534378
Name:GOLDEN GATE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:GOLDEN GATE PHARMACY SERVICES INC
Other - Org Name:GOLDEN GATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-455-9042
Mailing Address - Street 1:8 DIGITAL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5752
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:2005-11-08
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA407420Medicaid
0518564OtherOTHER ID NUMBER-COMMERCIAL NUMBER