Provider Demographics
NPI:1922389873
Name:GOEBEL, ED J II (RPH)
Entity Type:Individual
Prefix:MR
First Name:ED
Middle Name:J
Last Name:GOEBEL
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1998 BROADWAY
Mailing Address - Street 2:1501
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2281
Mailing Address - Country:US
Mailing Address - Phone:415-482-0191
Mailing Address - Fax:415-482-0194
Practice Address - Street 1:820 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1906
Practice Address - Country:US
Practice Address - Phone:415-482-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist