Individual provider Active NPI

Jenny Goetzmann, PHARMD

  • Pharmacist
  • Greenville, SC
National Provider Identifier
1336592179
Registry record updated Jul 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
36672 Issued in SC
Practice address
1818 Woodruff Rd
Greenville, SC 29607-5935
Phone
(864) 458-9565
NPI assigned
Jul 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 36672 SC Primary

Addresses

Primary practice location

1818 Woodruff Rd
Greenville, SC 29607-5935

Mailing address

112 Colewood PL
Simpsonville, SC 29681-3548

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
36672SCMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1468713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468713600000",
    "number": "1336592179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 COLEWOOD PL",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296813548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 WOODRUFF RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296075935",
            "telephone_number": "864-458-9565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOETZMANN",
        "first_name": "JENNY",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-17",
        "last_updated": "2016-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "36672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.