Goodwater Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

112684 Issued in AL

Legal business name

GOODWATER PHARMACY INC

Doing business as

Goodwater Pharmacy

Practice address

21338 Al Highway 9
Goodwater, AL 35072-6621

Phone

(256) 839-6361

Fax

(256) 839-6481

NPI assigned

Sep 12, 2006

Last updated

Jan 13, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Richard Collins, RPH

Title

President

Phone

(256) 839-6361

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• GOODWATER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1154425106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 48",
            "city": "GOODWATER",
            "state": "AL",
            "postal_code": "350720048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21338 AL HIGHWAY 9",
            "city": "GOODWATER",
            "state": "AL",
            "postal_code": "350726621",
            "telephone_number": "256-839-6361",
            "fax_number": "256-839-6481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODWATER PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-839-6361",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "112684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100003637",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1995706",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOODWATER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• A Better You LLC
• City of Goodwater/Amb SRV
• Fresh Rides LLC
• Goodwater Healthcare Center
• Goodwater Healthcare Center LLC
• Antweshia Hawes-Wood
• Health Services, Inc. (Goodwater Family Health Center)
• Teresa Jones, NP
• Cameron Elaine Lackey, M.S., BCBA
• Nurturing Hope LLC

• Community/Retail Pharmacy in Goodwater, AL
• Providers in Goodwater, AL by specialty
• Community/Retail Pharmacy in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.