MEDICARE: TASHI GONPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	74360	CA

General Provider Information

NPI Number	:	1558725168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHI GONPO

Provider Business Mailing Address
First Line	:	405 FOREST PARK
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-3904
Country	:	US
Telephone Number	:	310-666-7465
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 NORTHGATE DR
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-3671
Country	:	US
Telephone Number	:	415-492-0888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2016
Last Update Date	:	04/09/2016

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Directions to “ TASHI GONPO ” Practice Location

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