Provider Demographics
NPI:1477144053
Name:GOLDBERG, STEPHEN M (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROCKY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1755
Mailing Address - Country:US
Mailing Address - Phone:978-777-1557
Mailing Address - Fax:
Practice Address - Street 1:STOP AND SHOP PHARMACY
Practice Address - Street 2:35 WASHINGTON ST
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901
Practice Address - Country:US
Practice Address - Phone:781-596-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH16060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist