Provider Demographics
NPI:1174809768
Name:GOLL, DAVID RONALD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RONALD
Last Name:GOLL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:DD-30
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-0873
Mailing Address - Fax:216-636-5272
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:DD-30
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-0873
Practice Address - Fax:216-636-5272
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49998183500000X
OH03132067-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX49998OtherTEXAS STATE BOARD OF PHARMACY
OH03132067-1OtherOHIO BOARD OF PHARMACY