Provider Demographics
NPI:1891855029
Name:NORTHGATE PHARMACY INC
Entity Type:Organization
Organization Name:NORTHGATE PHARMACY INC
Other - Org Name:ARLINGTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARM
Authorized Official - Prefix:
Authorized Official - First Name:WING
Authorized Official - Middle Name:
Authorized Official - Last Name:GEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:510-526-6414
Mailing Address - Street 1:299 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1401
Mailing Address - Country:US
Mailing Address - Phone:510-526-6414
Mailing Address - Fax:510-526-6832
Practice Address - Street 1:299 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CA
Practice Address - Zip Code:94707-1401
Practice Address - Country:US
Practice Address - Phone:510-526-6414
Practice Address - Fax:510-526-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY405573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0529050OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHY40557Medicaid