Jennie Goodman, RPH
Individual provider Active NPI Pharmacist · Blountstown, FL
NPI 1508908963 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508908963
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS14766 (FL)
- Practice address
- 17324 Main St N
Blountstown, FL 32424-1763 - Phone
- (850) 674-4557
- NPI assigned
- Feb 13, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| PS14766 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Golden Pharmacy,Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS14766 | FL | Yes |
Addresses
Primary practice location
17324 Main St N
Blountstown, FL 32424-1763
Mailing address
1510 Jenkins Ave
Bonifay, FL 32425-3159
Phone (850) 547-0414
Other providers in Blountstown, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.