Provider Demographics
NPI:1245390905
Name:GOLDENBERG, STANLEY BLAKE (BS PH FASCP)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:BLAKE
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:BS PH FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 STANFORD ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2221
Mailing Address - Country:US
Mailing Address - Phone:818-788-5810
Mailing Address - Fax:818-981-4947
Practice Address - Street 1:5353 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2804
Practice Address - Country:US
Practice Address - Phone:818-788-2411
Practice Address - Fax:818-981-4947
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist