Provider Demographics
NPI:1427372853
Name:GOLDMAN, STELLA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:STELLA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OCEANA DR E
Mailing Address - Street 2:APT # PH1D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6691
Mailing Address - Country:US
Mailing Address - Phone:718-644-4590
Mailing Address - Fax:212-233-0444
Practice Address - Street 1:125 OCEANA DR E
Practice Address - Street 2:APT # PH1D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6691
Practice Address - Country:US
Practice Address - Phone:718-644-4590
Practice Address - Fax:212-233-0444
Is Sole Proprietor?:No
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist