Provider Demographics
NPI:1720355605
Name:GOLDBERG, JEFFREY EDWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EDWARD
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TAMMANY ST
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1752
Mailing Address - Country:US
Mailing Address - Phone:406-560-1857
Mailing Address - Fax:
Practice Address - Street 1:1525 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-1829
Practice Address - Country:US
Practice Address - Phone:406-563-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist