Provider Demographics
NPI:1689822819
Name:GOOMBS, TAHRIK ALFANCE (PHARMD,RPH)
Entity Type:Individual
Prefix:DR
First Name:TAHRIK
Middle Name:ALFANCE
Last Name:GOOMBS
Suffix:
Gender:M
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11709 KNIGHTSBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-7414
Mailing Address - Country:US
Mailing Address - Phone:954-591-1160
Mailing Address - Fax:
Practice Address - Street 1:11709 KNIGHTSBRIDGE PL
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-7414
Practice Address - Country:US
Practice Address - Phone:954-591-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist