Provider Demographics
NPI:1063409340
Name:GOLDMAN, ALAN MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:MICHAEL
Last Name:GOLDMAN
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 1:4557 CANTERWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8712
Mailing Address - Country:US
Mailing Address - Phone:616-942-9946
Mailing Address - Fax:
Practice Address - Street 1:20 SHELDON BLVD SE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4210
Practice Address - Country:US
Practice Address - Phone:616-913-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027850183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric