Healthcare Provider Details

I. General information

NPI: 1780781617
Provider Name (Legal Business Name): W H GOODALE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N SUSSEX ST
DOVER NJ
07801-3958
US

IV. Provider business mailing address

16 N SUSSEX ST
DOVER NJ
07801-3958
US

V. Phone/Fax

Practice location:
  • Phone: 973-366-0976
  • Fax: 973-366-3127
Mailing address:
  • Phone: 973-366-0976
  • Fax: 973-366-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00531900
License Number StateNJ

VIII. Authorized Official

Name: ROBERT PERGOLA
Title or Position: PRESIDENT
Credential:
Phone: 973-366-0976