MEDICARE: GO RED CORP

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	3336C0003X	Community/Retail Pharmacy	PHY 48609	CA

General Provider Information

NPI Number	:	1780885533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO RED CORP

Provider Business Mailing Address
First Line	:	5705 MARKET ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2811
Country	:	US
Telephone Number	:	510-652-7537
Fax Number	:	510-652-5388

Provider Business Practice Location Address
First Line	:	5705 MARKET ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2811
Country	:	US
Telephone Number	:	510-652-7537
Fax Number	:	510-652-5388

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SUMEEET GORE
Credential	:
Telephone Number	:	510-652-7537

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/22/2020

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Directions to “GO RED CORP ” Practice Location

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