Provider Demographics
NPI:1912005513
Name:GOLDEN GATE PHARMACY, INC
Entity Type:Organization
Organization Name:GOLDEN GATE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-455-3124
Mailing Address - Street 1:11669 COLLIER BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-6530
Mailing Address - Country:US
Mailing Address - Phone:239-455-3124
Mailing Address - Fax:239-455-2834
Practice Address - Street 1:11669 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-6530
Practice Address - Country:US
Practice Address - Phone:239-455-3124
Practice Address - Fax:239-455-2834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH119923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0679700001Medicare ID - Type Unspecified