Provider Demographics
NPI:1841421609
Name:GOLDSBOROUGH, ADAM MICHAEL (CPHT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:GOLDSBOROUGH
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 STATE ROAD 54
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2217
Mailing Address - Country:US
Mailing Address - Phone:727-375-2502
Mailing Address - Fax:727-375-2508
Practice Address - Street 1:10720 STATE ROAD 54
Practice Address - Street 2:SUITE 103
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-2217
Practice Address - Country:US
Practice Address - Phone:727-375-2502
Practice Address - Fax:727-375-2508
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35010106340294183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350101060340294OtherCERTIFIED PHARMACY TECHINICIAN