Provider Demographics
NPI:1003047077
Name:GOODMAN, DAVID A (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 VETERANS AVE
Mailing Address - Street 2:PHARMACY DEPT (119)
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-0810
Mailing Address - Country:US
Mailing Address - Phone:607-664-4469
Mailing Address - Fax:607-664-4478
Practice Address - Street 1:76 VETERANS AVE
Practice Address - Street 2:PHARMACY DEPT (119)
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-0810
Practice Address - Country:US
Practice Address - Phone:607-664-4469
Practice Address - Fax:607-664-4478
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051132-11835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist