Provider Demographics
NPI:1194927756
Name:GOODMAN, BERNARD J (RPH)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:J
Last Name:GOODMAN
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 1:2107 DUMFRIES TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1663
Mailing Address - Country:US
Mailing Address - Phone:301-404-5163
Mailing Address - Fax:
Practice Address - Street 1:9812 FALLS RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3976
Practice Address - Country:US
Practice Address - Phone:301-983-4217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist