Healthcare Provider Details

I. General information

NPI: 1831859107
Provider Name (Legal Business Name): TARAN GOODBALLET PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 N 83RD AVE
PEORIA AZ
85381-5658
US

IV. Provider business mailing address

14100 N 83RD AVE
PEORIA AZ
85381-5658
US

V. Phone/Fax

Practice location:
  • Phone: 623-230-3194
  • Fax:
Mailing address:
  • Phone: 623-230-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberS024801
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: