Provider Demographics
NPI:1225259492
Name:GOREN, MICHAEL S (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:GOREN
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 1:775 BELL RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9509
Mailing Address - Country:US
Mailing Address - Phone:941-342-2500
Mailing Address - Fax:941-377-3294
Practice Address - Street 1:775 BELL ROAD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240
Practice Address - Country:US
Practice Address - Phone:941-342-2500
Practice Address - Fax:941-377-3294
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38195183500000X
TN11353183500000X
MA19136183500000X
NH2409183500000X
VA0202209065183500000X
NE12835183500000X
LA18303183500000X
KY013632183500000X
AZS018260183500000X
ARPD09048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist