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General NPI Number Information
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NPI Number | 1487938981
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Entity Type | Individual
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Provider Name | CARLA GOLDBERG
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Gender | Female
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 655 WYCKOFF AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481
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Country | US
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Telephone | 201-891-5373
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Fax |
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Provider Business Mailing Address
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Address Line | 718 TEANECK RD STE 2
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City | TEANECK
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State | NJ
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Zip | 07666-4245
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Country | US
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Telephone | 201-530-7991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03274300
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License Number State | NJ
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