Provider Demographics
NPI:1861865255
Name:GOLDGRABEN, PAUL R (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:GOLDGRABEN
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 1:8 AYERS RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560
Mailing Address - Country:US
Mailing Address - Phone:516-637-7981
Mailing Address - Fax:
Practice Address - Street 1:436 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1935
Practice Address - Country:US
Practice Address - Phone:718-339-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist