Provider Demographics
NPI:1679857205
Name:GOLDBERGER, ELEONORA (PHAMD)
Entity Type:Individual
Prefix:MISS
First Name:ELEONORA
Middle Name:
Last Name:GOLDBERGER
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 JORDAN CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3869
Mailing Address - Country:US
Mailing Address - Phone:678-823-4978
Mailing Address - Fax:
Practice Address - Street 1:2855 JORDAN CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3869
Practice Address - Country:US
Practice Address - Phone:678-823-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist