Goose Pharma, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GOOSE PHARMA, LLC

Practice address

18049 Magnolia Street
Fountain Valley, CA 92708

Phone

(510) 610-1336

NPI assigned

Aug 18, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jenny Dang, PHARMD.NPI 1669850285

Title

Manager

Phone

(510) 610-1336

Specialties & licenses 2

Addresses

Other names 1

• One Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Tax ID family

Goose Pharma LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Goose Pharma, LLC

  • Long Term Care Pharmacy
  • Fountain Valley, CA
  • NPI 1548924707
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jenny Dang, PHARMD

  • Pharmacist
  • Huntington Beach, CA
  • NPI 1669850285
  NPD Authorized official
• Anhduong Hoang Nguyen, PHARMD

  • Pharmacist
  • Fountain Valley, CA
  • NPI 1073165155
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503014400000",
    "number": "1144746348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18049 MAGNOLIA ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927085638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18049 MAGNOLIA STREET",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "92708",
            "telephone_number": "510-610-1336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOSE PHARMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2017-08-18",
        "status": "A",
        "authorized_official_last_name": "DANG",
        "authorized_official_first_name": "JENNY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "510-610-1336",
        "authorized_official_credential": "PHARMD."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "One Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gryska I Gonzalez, PA-C
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• Judy B. Goodman, L.M.F.T.
• Goose Pharma, LLC
• Gordon K. Ota, O.D. a Professional Corporation
• Kresta Grabau, RN
• Richard John Grainey, MD
• Arlen Grajeda, LMFT

• Community/Retail Pharmacy in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.