Provider Demographics
NPI:1255655247
Name:GOLDBERG PHARMACY INC
Entity Type:Organization
Organization Name:GOLDBERG PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-414-7170
Mailing Address - Street 1:39500 W 10 MILE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2947
Mailing Address - Country:US
Mailing Address - Phone:248-474-3333
Mailing Address - Fax:
Practice Address - Street 1:39500 W 10 MILE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2947
Practice Address - Country:US
Practice Address - Phone:248-474-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy