Amanda Marie Goodall, PHARMD

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

18793-40 Issued in WI

Practice address

2950 New Pinery Rd
Portage, WI 53901-9225

Phone

(608) 742-1670

Fax

(608) 742-1769

NPI assigned

Oct 18, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1602979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602979200000",
    "number": "1578162954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3072 LARSEN RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537115729",
            "telephone_number": "608-333-1559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019225",
            "telephone_number": "608-742-1670",
            "fax_number": "608-742-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODALL",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-18",
        "last_updated": "2020-10-18",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "18793-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Conner Funnell
• James T Gariti Sr., MD
• Jeffry S Goldthorpe, O.D.
• Julie Lueck Goldthorpe, O.D.
• William Scott Goldthorpe, O.D.
• Heather Jane Gove, LPC
• Bliss Grady, PA-C
• Angela Marie Gray
• Nicki Greeley, LPC, CADC
• Lori N Greer, PSYD

• Community/Retail Pharmacy in Portage, WI
• Providers in Portage, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2020; 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.