Provider Demographics
NPI:1942347422
Name:GOODMAN, JEROME MORRIS (R PH)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:MORRIS
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3323
Mailing Address - Country:US
Mailing Address - Phone:513-984-1558
Mailing Address - Fax:513-984-1559
Practice Address - Street 1:3662 COOPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-3323
Practice Address - Country:US
Practice Address - Phone:513-984-1558
Practice Address - Fax:513-984-1559
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-08584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist