Individual provider Active NPI

Sally Lynne Goodson, R.PH.

  • Geriatric Pharmacist
  • Wichita, KS
National Provider Identifier
1629425012
Registry record updated May 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric PharmacistTaxonomy code 1835G0303X
License
9677 Issued in KS
Practice address
2622 W Central Ave
Suite 302
Wichita, KS 67203-4969
Phone
(316) 265-3300
Fax
(316) 265-3304
NPI assigned
May 16, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Pharmacist 1835G0303X 9677 KS Primary

Addresses

Primary practice location

2622 W Central Ave
Suite 302
Wichita, KS 67203-4969

Mailing address

2622 W Central Ave
Suite 302
Wichita, KS 67203-4969
Phone (316) 265-3300

Other identifiers 1

IdentifierTypeStateIssuer
709829OtherKSNABP

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
9677KSMDGeriatric Pharmacist

NPI Registry JSON

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

{
    "created_epoch": "1463356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463356800000",
    "number": "1629425012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2622 W CENTRAL AVE",
            "address_2": "SUITE 302",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672034969",
            "telephone_number": "316-265-3300",
            "fax_number": "316-265-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2622 W CENTRAL AVE",
            "address_2": "SUITE 302",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672034969",
            "telephone_number": "316-265-3300",
            "fax_number": "316-265-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODSON",
        "first_name": "SALLY",
        "middle_name": "LYNNE",
        "name_prefix": "Ms.",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-16",
        "last_updated": "2016-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "KS",
            "license": "9677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "709829",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.