Provider Demographics
NPI:1245577386
Name:GOLDSTEIN, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 MARKET BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-6711
Mailing Address - Country:US
Mailing Address - Phone:770-640-6088
Mailing Address - Fax:770-640-6362
Practice Address - Street 1:1425 MARKET BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6711
Practice Address - Country:US
Practice Address - Phone:770-640-6088
Practice Address - Fax:770-640-6362
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist