Provider Demographics
NPI:1982298980
Name:GOODMAN, CHRISTOPHER D (CPHT, CSPT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:D
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:CPHT, CSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 POTTSVILLE PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-4104
Mailing Address - Country:US
Mailing Address - Phone:570-622-8150
Mailing Address - Fax:
Practice Address - Street 1:500 POTTSVILLE PARK PLZ
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-4104
Practice Address - Country:US
Practice Address - Phone:570-622-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30027838183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician