Provider Demographics
NPI:1114975927
Name:GOLDBERG, NICOLE J (PHARMD, RPH, CGP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:J
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PHARMD, RPH, CGP
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:J
Other - Last Name:MROSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH, CGP
Mailing Address - Street 1:1270 S WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1824
Mailing Address - Country:US
Mailing Address - Phone:303-433-1776
Mailing Address - Fax:
Practice Address - Street 1:200 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2903
Practice Address - Country:US
Practice Address - Phone:720-974-6761
Practice Address - Fax:303-996-1600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist