Provider Demographics
NPI:1639497738
Name:GOEDECKER, WILLIAM A (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:GOEDECKER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4500
Mailing Address - Country:US
Mailing Address - Phone:973-893-9326
Mailing Address - Fax:
Practice Address - Street 1:100 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3266
Practice Address - Country:US
Practice Address - Phone:973-661-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01354000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist