Healthcare Provider Details

I. General information

NPI: 1396051843
Provider Name (Legal Business Name): JOHN ANDREW GOFUS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2010
Last Update Date: 08/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 W BAY AVE
BARNEGAT NJ
08005-2121
US

IV. Provider business mailing address

1017 EVERGREEN RD
YARDLEY PA
19067-1017
US

V. Phone/Fax

Practice location:
  • Phone: 609-698-2329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP028463L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01448000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: