NPIMap

Individual provider Active NPI

David J Goodman, RPH.

  • Pharmacist
  • Venice, FL
National Provider Identifier
1013286970
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS15965 Issued in FL
Practice address
1405 E Venice Ave
Venice, FL 34292-3064
Phone
(941) 488-8122
Fax
(941) 488-8130
NPI assigned
Dec 22, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS15965 FL Primary

Addresses

Primary practice location

1405 E Venice Ave
Venice, FL 34292-3064

Mailing address

1405 E Venice Ave
Venice, FL 34292-3064
Phone (941) 488-8122

Other identifiers 1

IdentifierTypeStateIssuer
PS15965OtherFLPHARMACIST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
PS15965FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1013286970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 E VENICE AVE",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342923064",
            "telephone_number": "941-488-8122",
            "fax_number": "941-488-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 E VENICE AVE",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342923064",
            "telephone_number": "941-488-8122",
            "fax_number": "941-488-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "DAVID",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "RPH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-22",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS15965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST",
            "identifier": "PS15965",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.