Provider Demographics
NPI:1730524935
Name:GOON, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:GOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 REMBRANDT WAY
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2991
Mailing Address - Country:US
Mailing Address - Phone:609-918-1083
Mailing Address - Fax:
Practice Address - Street 1:1195 ROUTE 70 STE 1006
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5946
Practice Address - Country:US
Practice Address - Phone:732-994-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02479200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist