Provider Demographics
NPI:1275607947
Name:DELA CRUZ-GOODMAN, FRANCINE (BS PHARM, PHARMD)
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:DELA CRUZ-GOODMAN
Suffix:
Gender:F
Credentials:BS PHARM, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 WINDJAMMER DR
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-9387
Mailing Address - Country:US
Mailing Address - Phone:803-547-1069
Mailing Address - Fax:
Practice Address - Street 1:1ST AVE (1 BLOCK NORTH OF CERMAK RD)
Practice Address - Street 2:BLDG 37 RM 139
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-786-7862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy