Provider Demographics
NPI:1760218226
Name:GOLDSTEIN, ERIC MICHAEL
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:MICHAEL
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 ROUTE 73 S
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2048
Mailing Address - Country:US
Mailing Address - Phone:856-988-6164
Mailing Address - Fax:856-988-1415
Practice Address - Street 1:404 ROUTE 73 S
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2048
Practice Address - Country:US
Practice Address - Phone:856-988-6164
Practice Address - Fax:856-988-1415
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW00318500183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician