Provider Demographics
NPI:1730217142
Name:WILLIAM CALVIN GOSS
Entity type:Organization
Organization Name:WILLIAM CALVIN GOSS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARM TECH
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-284-6618
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95947-0039
Mailing Address - Country:US
Mailing Address - Phone:530-284-6618
Mailing Address - Fax:530-284-6940
Practice Address - Street 1:225 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:CA
Practice Address - Zip Code:95947-9707
Practice Address - Country:US
Practice Address - Phone:530-284-6618
Practice Address - Fax:530-284-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY404063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0593524OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA404060Medicaid
CAPHA404060Medicaid