Provider Demographics
NPI:1538348461
Name:BLOODGOOD, JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:BLOODGOOD
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 1:4 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4003
Mailing Address - Country:US
Mailing Address - Phone:631-351-6456
Mailing Address - Fax:
Practice Address - Street 1:35 MIDDLE COUNTRY RD STE H
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4478
Practice Address - Country:US
Practice Address - Phone:631-698-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist