Provider Demographics
NPI:1063840817
Name:GOLDING, MICHAEL MARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MARK
Last Name:GOLDING
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 1:21301 S TAMIAMI TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2943
Mailing Address - Country:US
Mailing Address - Phone:239-948-1182
Mailing Address - Fax:
Practice Address - Street 1:21301 S TAMIAMI TRL STE 200
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-2943
Practice Address - Country:US
Practice Address - Phone:239-948-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist