Provider Demographics
NPI:1417948464
Name:GOLDMAN, MORT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MORT
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24116 E GROVELAND RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1213
Mailing Address - Country:US
Mailing Address - Phone:216-444-1127
Mailing Address - Fax:216-444-4380
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:QQB-5
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-1127
Practice Address - Fax:216-444-4380
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-151631835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy