Healthcare Provider Details

I. General information

NPI: 1063409340
Provider Name (Legal Business Name): ALAN MICHAEL GOLDMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SHELDON BLVD SE SUITE 100
GRAND RAPIDS MI
49503-4210
US

IV. Provider business mailing address

4557 CANTERWOOD DR NE
ADA MI
49301-8712
US

V. Phone/Fax

Practice location:
  • Phone: 616-913-1111
  • Fax:
Mailing address:
  • Phone: 616-942-9946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302027850
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number5302027850
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: