Provider Demographics
NPI:1598011686
Name:GOLDMAN, MICHAEL NEIL (CPHT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NEIL
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HOCKANUM BLVD
Mailing Address - Street 2:UNIT 4923
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4099
Mailing Address - Country:US
Mailing Address - Phone:508-561-8570
Mailing Address - Fax:
Practice Address - Street 1:188 UNION ST
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-2429
Practice Address - Country:US
Practice Address - Phone:860-232-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician