Provider Demographics
NPI:1699027979
Name:GOLDSTEIN, ALLEN STUART
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:STUART
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 LINDERO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4063
Mailing Address - Country:US
Mailing Address - Phone:818-597-3904
Mailing Address - Fax:818-597-3912
Practice Address - Street 1:5700 LINDERO CANYON RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4063
Practice Address - Country:US
Practice Address - Phone:818-597-3904
Practice Address - Fax:818-597-3912
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist