Provider Demographics
NPI:1366789372
Name:GOODMAN, BRYAN JOSEPH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JOSEPH
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 LAUREL CANYON VILLAGE CIR
Mailing Address - Street 2:118
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-4469
Mailing Address - Country:US
Mailing Address - Phone:770-479-3711
Mailing Address - Fax:770-479-3777
Practice Address - Street 1:15 LAUREL CANYON VILLAGE CIR
Practice Address - Street 2:118
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4469
Practice Address - Country:US
Practice Address - Phone:770-479-3711
Practice Address - Fax:770-479-3777
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist