Provider Demographics
NPI:1396747192
Name:GOLDMAN, JENNIFER D (PHARMD, CDE)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:D
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PHARMD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5804
Mailing Address - Country:US
Mailing Address - Phone:617-732-2917
Mailing Address - Fax:
Practice Address - Street 1:2 1ST AVE
Practice Address - Street 2:WELL LIFE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4959
Practice Address - Country:US
Practice Address - Phone:978-740-2300
Practice Address - Fax:978-744-5148
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209831835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy