Provider Demographics
NPI:1134659030
Name:GOLDEN, JACK CLIFFORD JR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:CLIFFORD
Last Name:GOLDEN
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LEE ROAD 545
Mailing Address - Street 2:
Mailing Address - City:SMITHS STATION
Mailing Address - State:AL
Mailing Address - Zip Code:36877-4616
Mailing Address - Country:US
Mailing Address - Phone:334-291-1814
Mailing Address - Fax:334-291-0773
Practice Address - Street 1:3700 US HWY 280/431N
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867
Practice Address - Country:US
Practice Address - Phone:334-291-1814
Practice Address - Fax:334-291-0773
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist