Provider Demographics
NPI:1619298700
Name:GOLDBERG, KYLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:GOLDBERG
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 1:13 PALMER CIR
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08535-8546
Mailing Address - Country:US
Mailing Address - Phone:908-216-7959
Mailing Address - Fax:
Practice Address - Street 1:2235 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1100
Practice Address - Country:US
Practice Address - Phone:908-622-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03300400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist