MEDICARE: GOLDSTEIN PHARMACEUTICALS SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	Y002107	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0305993	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386655959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDSTEIN PHARMACEUTICALS SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 80555
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85060-0555
Country	:	US
Telephone Number	:	602-956-8540
Fax Number	:	602-956-5423

Provider Business Practice Location Address
First Line	:	3628 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7502
Country	:	US
Telephone Number	:	602-956-8540
Fax Number	:	602-957-0291

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY GOLDSTEIN
Credential	:
Telephone Number	:	602-956-8540

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/13/2011

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