Jay B Goble, RPH
Individual provider Active NPI Pharmacist · Chandler, AZ
NPI 1306369939 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1306369939
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- S016268 (AZ)
- Practice address
- 3466 E Glacier PL
Chandler, AZ 85249-5181 - Phone
- (480) 621-2003
- NPI assigned
- Jul 25, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S016268 | AZ | MD | Pharmacist |
| 26027299A | IN | MD | Pharmacist |
| 1-103431 | KS | MD | Pharmacist |
| 043715 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26027299A | IN | |
| Pharmacist | 183500000X | 1-103431 | KS | |
| Pharmacist | 183500000X | 043715 | MO | |
| Pharmacist | 183500000X | S016268 | AZ | Yes |
Addresses
Primary practice location
3466 E Glacier PL
Chandler, AZ 85249-5181
Mailing address
3466 E Glacier PL
Chandler, AZ 85249-5181
Phone (480) 621-2003
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| S016268 | Other | AZ | PHARMACIST LICENSE |
| 043715 | Other | MO | PHARMACIST LICENSE |
| 26027299A | Other | IN | PHARMACIST LICENSE |
| 1-103431 | Other | KS | PHARMACIST LICENSE |
Other providers in Chandler, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.