MEDICARE: NORTHGATE PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY40557	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0529050	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891855029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHGATE PHARMACY INC

Provider Business Mailing Address
First Line	:	299 ARLINGTON AVE
Second Line	:
City	:	KENSINGTON
State	:	CA
Zip	:	94707-1401
Country	:	US
Telephone Number	:	510-526-6414
Fax Number	:	510-526-6832

Provider Business Practice Location Address
First Line	:	299 ARLINGTON AVE
Second Line	:
City	:	KENSINGTON
State	:	CA
Zip	:	94707-1401
Country	:	US
Telephone Number	:	510-526-6414
Fax Number	:	510-526-6832

Authorized Official
Title or Position	:	OWNER AND PHARM
Name	:	WING GEE
Credential	:	PHARM D
Telephone Number	:	510-526-6414

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	03/25/2010

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Directions to “NORTHGATE PHARMACY INC ” Practice Location

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