MEDICARE: GOODMAN DRUGS OF FL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PH 12431	FL
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1009922	OTHER	FL	NABP
2	1070882	OTHER	FL	NABP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780712323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODMAN DRUGS OF FL CORP

Provider Business Mailing Address
First Line	:	1078 S POWERLINE ROAD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442
Country	:	US
Telephone Number	:	954-637-8855
Fax Number	:	855-315-7478

Provider Business Practice Location Address
First Line	:	1234 NE 4TH AVENUE
Second Line	:	SUITE C
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304
Country	:	US
Telephone Number	:	954-764-6257
Fax Number	:	954-764-3175

Authorized Official
Title or Position	:	OWNER
Name	:	SHERINE BAHNA
Credential	:	PHARM. D.
Telephone Number	:	954-637-8855

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	11/22/2016

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