Provider Demographics
NPI:1255931432
Name:GOLDSBERRY, MICHELLE LYNN (RPH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:GOLDSBERRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 JOHN WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-9153
Mailing Address - Country:US
Mailing Address - Phone:812-275-0415
Mailing Address - Fax:812-275-0375
Practice Address - Street 1:3200 JOHN WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-9153
Practice Address - Country:US
Practice Address - Phone:812-275-0415
Practice Address - Fax:812-275-0375
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017937A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist