Organization
IRA S GOLD
Active
Other names
FOOTHILL MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
IRA GOLD (OWNER)
(408) 739-3452
Entity
Organization
Contact information
Practice address
877 W FREMONT AVE, STE A1, SUNNYVALE, CA 94087-2315
(408) 739-3452
(408) 739-0848
Mailing address
PO BOX 700247, SAN JOSE, CA 95170-0247
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY38948
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0548478
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHD151060
—
CA
Enumeration date
08/10/2006
Last updated
10/04/2011
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