Provider Demographics
NPI:1376837641
Name:GOOZEN, BENJAMIN MATTHEW (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MATTHEW
Last Name:GOOZEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13731 W BELL RD
Mailing Address - Street 2:T-1335
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3871
Mailing Address - Country:US
Mailing Address - Phone:623-975-4379
Mailing Address - Fax:623-975-4379
Practice Address - Street 1:13731 W BELL RD
Practice Address - Street 2:T-1335
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3871
Practice Address - Country:US
Practice Address - Phone:623-975-4379
Practice Address - Fax:623-975-4379
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist