Provider Demographics
NPI:1841398450
Name:GOLDBLATT, STANLEY (RPH)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:GOLDBLATT
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 1:1399 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-6642
Mailing Address - Country:US
Mailing Address - Phone:561-615-0564
Mailing Address - Fax:561-615-4508
Practice Address - Street 1:1689 FORUM PL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2303
Practice Address - Country:US
Practice Address - Phone:561-615-0564
Practice Address - Fax:561-615-4508
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS13734183500000X
FLPU4491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSTATE LICENSE NUMBEROtherPS13734