Provider Demographics
NPI:1801982897
Name:GOODMANSON, DAVID A (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GOODMANSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E WOOLBRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6007
Mailing Address - Country:US
Mailing Address - Phone:561-736-1010
Mailing Address - Fax:561-736-1272
Practice Address - Street 1:141 E WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6007
Practice Address - Country:US
Practice Address - Phone:561-736-1010
Practice Address - Fax:561-736-1272
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH15100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist