Miles Goode Jr., RPH
Individual provider Active NPI Pharmacist · Jackson, MS
NPI 1194122283 · NPPES record last updated Dec 4, 2014
Key facts
- NPI
- 1194122283
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- E7716 (MS)
- Practice address
- 380 W Woodrow Wilson Ave
Jackson, MS 39213-7657 - Phone
- (601) 713-1130
- NPI assigned
- Dec 4, 2014
- 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 |
|---|---|---|---|
| E7716 | MS | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E7716 | MS | Yes |
Addresses
Primary practice location
380 W Woodrow Wilson Ave
Jackson, MS 39213-7657
Mailing address
380 W Woodrow Wilson Ave
Jackson, MS 39213-7657
Phone (601) 713-1130
Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2014. 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.