Provider Demographics
NPI:1205117488
Name:GOLDMAN, STANLEY BRUCE (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:BRUCE
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 NW 125TH LN
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4552
Mailing Address - Country:US
Mailing Address - Phone:954-757-8501
Mailing Address - Fax:
Practice Address - Street 1:7810 NW 125TH LN
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4552
Practice Address - Country:US
Practice Address - Phone:954-757-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS10946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist