Provider Demographics
NPI:1326340159
Name:GOLDENBERG, SHAYLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ACME ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3306
Mailing Address - Country:US
Mailing Address - Phone:740-374-2523
Mailing Address - Fax:740-568-0480
Practice Address - Street 1:40 ACME ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3306
Practice Address - Country:US
Practice Address - Phone:740-374-2523
Practice Address - Fax:740-568-0480
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225359183500000X
WVRP0006478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist