Provider Demographics
NPI:1851421242
Name:GOYCO, ERIC A (RPH)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:A
Last Name:GOYCO
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 1:8169 CALLE CONCORDIA
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1554
Mailing Address - Country:US
Mailing Address - Phone:787-842-9169
Mailing Address - Fax:787-842-9169
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:SUITE 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1554
Practice Address - Country:US
Practice Address - Phone:787-842-9169
Practice Address - Fax:787-842-9169
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4015992OtherNCPDP