Provider Demographics
NPI:1619332301
Name:GOLDS PHARMACY INC
Entity Type:Organization
Organization Name:GOLDS PHARMACY INC
Other - Org Name:GOLD'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-879-4653
Mailing Address - Street 1:7543 HAVERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2226
Mailing Address - Country:US
Mailing Address - Phone:215-879-4653
Mailing Address - Fax:215-879-4600
Practice Address - Street 1:7543 HAVERFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2226
Practice Address - Country:US
Practice Address - Phone:215-879-4653
Practice Address - Fax:215-878-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482609333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030687740001Medicaid
2156159OtherPK