Provider Demographics
NPI:1962660043
Name:EISENBERG GOLDBERG, BARBARA RENEE (RPH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:RENEE
Last Name:EISENBERG GOLDBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:RENEE
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1602 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-5601
Mailing Address - Country:US
Mailing Address - Phone:248-225-0201
Mailing Address - Fax:
Practice Address - Street 1:1602 MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-5601
Practice Address - Country:US
Practice Address - Phone:248-225-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist