Provider Demographics
NPI:1316542145
Name:GOLDSBY, NANCY O
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:O
Last Name:GOLDSBY
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 1:822 W PENSACOLA ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-8036
Mailing Address - Country:US
Mailing Address - Phone:850-841-1049
Mailing Address - Fax:850-841-1059
Practice Address - Street 1:822 W PENSACOLA ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-8036
Practice Address - Country:US
Practice Address - Phone:850-841-1049
Practice Address - Fax:850-841-1059
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist