Provider Demographics
NPI:1124401211
Name:GOULD, FRED JOEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:JOEL
Last Name:GOULD
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 1:29711 BADEN PL
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3842
Mailing Address - Country:US
Mailing Address - Phone:310-457-2743
Mailing Address - Fax:310-457-2743
Practice Address - Street 1:29711 BADEN PL
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3842
Practice Address - Country:US
Practice Address - Phone:310-457-2743
Practice Address - Fax:310-457-2743
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist