Provider Demographics
NPI:1366525719
Name:GOLDSMITH, PHILLIP (RPH)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:GOLDSMITH
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 1:22740 HEATHERWOODE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4449
Mailing Address - Country:US
Mailing Address - Phone:248-349-8852
Mailing Address - Fax:248-349-8851
Practice Address - Street 1:34500 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3090
Practice Address - Country:US
Practice Address - Phone:734-729-2200
Practice Address - Fax:734-729-3857
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist