Amber Goodloe
Individual provider Active NPI Pharmacist · Madera, CA
NPI 1154801884 · NPPES record last updated Aug 21, 2018
Key facts
- NPI
- 1154801884
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 78447 (CA)
- Practice address
- 1400 Howard Rd
Madera, CA 93637-5125 - Phone
- (559) 661-8380
- NPI assigned
- Aug 21, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78447 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longs Drug Stores California LLC | Past | Accepting new patients | |
| Longs Drug Store California LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 78447 | CA | Yes |
Addresses
Primary practice location
1400 Howard Rd
Madera, CA 93637-5125
Mailing address
1400 Howard Rd
Madera, CA 93637-5125
Phone (559) 661-8380
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760424592 | Medicaid | CA |
Other providers in Madera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2018. 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.