MEDICARE: GO RED CORPORATION

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	3336C0002X	Clinic Pharmacy
2	333600000X	Pharmacy
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	48609	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2066917	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952397044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO RED CORPORATION

Provider Business Mailing Address
First Line	:	5705 MARKET ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-2811
Country	:	US
Telephone Number	:	510-652-7536
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	:	510-652-7536
Fax Number	:	510-652-5388

Authorized Official
Title or Position	:	OWNER
Name	:	SUDHIR REDDY
Credential	:	PHRMD
Telephone Number	:	510-652-7536

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	01/20/2016

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Directions to “GO RED CORPORATION ” Practice Location

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