Healthcare Provider Details

I. General information

NPI: 1841201423
Provider Name (Legal Business Name): IRA S GOLD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 W FREMONT AVE STE A1
SUNNYVALE CA
94087-2315
US

IV. Provider business mailing address

PO BOX 700247
SAN JOSE CA
95170-0247
US

V. Phone/Fax

Practice location:
  • Phone: 408-739-3452
  • Fax: 408-739-0848
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY38948
License Number StateCA

VIII. Authorized Official

Name: IRA GOLD
Title or Position: OWNER
Credential:
Phone: 408-739-3452