Provider Demographics
NPI:1285798876
Name:PANJETON, GOLAM S (RPH CPH)
Entity type:Individual
Prefix:MR
First Name:GOLAM
Middle Name:S
Last Name:PANJETON
Suffix:
Gender:M
Credentials:RPH CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 IBISCA TERRACE
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4321
Mailing Address - Country:US
Mailing Address - Phone:561-358-4467
Mailing Address - Fax:561-422-0895
Practice Address - Street 1:116 IBISCA TERRACE
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4321
Practice Address - Country:US
Practice Address - Phone:561-358-4467
Practice Address - Fax:561-422-0895
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0015190183500000X
FLPU12491835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy