Healthcare Provider Details

I. General information

NPI: 1952397044
Provider Name (Legal Business Name): GO RED CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 MARKET ST
OAKLAND CA
94608-2811
US

IV. Provider business mailing address

5705 MARKET ST
OAKLAND CA
94608-2811
US

V. Phone/Fax

Practice location:
  • Phone: 510-652-7536
  • Fax: 510-652-5388
Mailing address:
  • Phone: 510-652-7536
  • Fax: 510-652-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number48609
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUDHIR REDDY
Title or Position: OWNER
Credential: PHRMD
Phone: 510-652-7536