Provider Demographics
NPI:1225057748
Name:GOLDENBERG, STANLEY WILLIAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:WILLIAM
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10625 LEVICO WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1902
Mailing Address - Country:US
Mailing Address - Phone:310-456-6867
Mailing Address - Fax:310-476-1211
Practice Address - Street 1:10625 LEVICO WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1902
Practice Address - Country:US
Practice Address - Phone:310-456-6867
Practice Address - Fax:310-476-1211
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHARMACIST LICENSE #Other25720