Provider Demographics
NPI:1689855835
Name:GOELZ, DONALD PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:PAUL
Last Name:GOELZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BUELL ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-1308
Mailing Address - Country:US
Mailing Address - Phone:716-542-9761
Mailing Address - Fax:716-542-4976
Practice Address - Street 1:81 BUELL ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:NY
Practice Address - Zip Code:14001-1308
Practice Address - Country:US
Practice Address - Phone:716-542-9761
Practice Address - Fax:716-542-4976
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01505953Medicaid