Provider Demographics
NPI:1639450539
Name:GOODMAN PHARMACY LLC
Entity Type:Organization
Organization Name:GOODMAN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARMD, PHD
Authorized Official - Phone:212-585-4663
Mailing Address - Street 1:779 MELROSE AVE.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4440
Mailing Address - Country:US
Mailing Address - Phone:718-585-4663
Mailing Address - Fax:718-585-4667
Practice Address - Street 1:779 MELROSE AVE.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4440
Practice Address - Country:US
Practice Address - Phone:718-585-4663
Practice Address - Fax:718-585-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy