Provider Demographics
NPI:1124310933
Name:GOLDBACH, MICHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:GOLDBACH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8093 BANKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5503
Mailing Address - Country:US
Mailing Address - Phone:770-489-6545
Mailing Address - Fax:
Practice Address - Street 1:128 LOVVORN AVE
Practice Address - Street 2:
Practice Address - City:BOWDON
Practice Address - State:GA
Practice Address - Zip Code:30108-1141
Practice Address - Country:US
Practice Address - Phone:770-258-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist