Healthcare Provider Details

I. General information

NPI: 1730675398
Provider Name (Legal Business Name): DANIEL GOLDBERG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 MAIN ST SE
LOS LUNAS NM
87031-6320
US

IV. Provider business mailing address

2351 MAIN ST SE
LOS LUNAS NM
87031-6320
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-2089
  • Fax:
Mailing address:
  • Phone: 505-865-2089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0008904
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: