Provider Demographics
NPI:1104149939
Name:GOLDMAN, NEIL R (RPH)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:R
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 1:437 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2597
Mailing Address - Country:US
Mailing Address - Phone:570-421-1110
Mailing Address - Fax:570-421-1207
Practice Address - Street 1:437 MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2597
Practice Address - Country:US
Practice Address - Phone:570-421-1110
Practice Address - Fax:570-421-1207
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027179L183500000X
NY023910-1183500000X
FLPS14762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist