Provider Demographics
NPI:1306420518
Name:GOBLE, BECKY LYNN (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:GOBLE
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W G ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3228
Mailing Address - Country:US
Mailing Address - Phone:909-984-3913
Mailing Address - Fax:
Practice Address - Street 1:222 W G ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3228
Practice Address - Country:US
Practice Address - Phone:909-984-3913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH70546183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician