Healthcare Provider Details

I. General information

NPI: 1427813377
Provider Name (Legal Business Name): JASON GOODMAN PHARMD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 MILLIKIN RD
COLUMBUS OH
43210-2200
US

IV. Provider business mailing address

1875 MILLIKIN RD
COLUMBUS OH
43210-2200
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-0125
  • Fax:
Mailing address:
  • Phone: 614-292-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56594
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328653
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: