Healthcare Provider Details

I. General information

NPI: 1700161957
Provider Name (Legal Business Name): BJ GOODRIDGE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W F ST
OAKDALE CA
95361-3501
US

IV. Provider business mailing address

1300 W F ST
OAKDALE CA
95361-3501
US

V. Phone/Fax

Practice location:
  • Phone: 209-847-1324
  • Fax:
Mailing address:
  • Phone: 209-847-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: