Active NPI
Robert Carroll Goodman Jr., PHARMD., BCPS
- Pharmacist
- Leitchfield, KY
National Provider Identifier
1689727398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 009475
- Practice address
- 908 Wallace Ave
Suite 105, Midway Pharmacy
Leitchfield, KY 42754-1479 - Phone
- (270) 259-8400
- Fax
- (270) 230-8517
- NPI assigned
- Jan 18, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 009475 | KY | Primary |
Addresses
Primary practice location
908 Wallace Ave
Suite 105, Midway Pharmacy
Leitchfield, KY 42754-1479
Mailing address
908 Wallace Ave
Suite 105, Midway Pharmacy
Leitchfield, KY 42754-1479
Phone (270) 259-8400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009475 | Other | KY | PHARMACIST LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 009475 | KY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689727398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "908 WALLACE AVE",
"address_2": "SUITE 105, MIDWAY PHARMACY",
"city": "LEITCHFIELD",
"state": "KY",
"postal_code": "427541479",
"telephone_number": "270-259-8400",
"fax_number": "270-230-8517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "908 WALLACE AVE",
"address_2": "SUITE 105, MIDWAY PHARMACY",
"city": "LEITCHFIELD",
"state": "KY",
"postal_code": "427541479",
"telephone_number": "270-259-8400",
"fax_number": "270-230-8517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "ROBERT",
"middle_name": "CARROLL",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PHARMD., BCPS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "009475",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "009475",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leitchfield, KY
- Jana Garcia, MSW, CSW
- Nathaniel J. Gastaldo, DPM
- Gay Fulkerson,M.D.,P.S.C.
- Angela Mae Gibson, PHARMD
- Scott Anthony Gibson, M.A.
- Martin Gravil, PHARM D
- Grayson County Board of Education
- Grayson County Emergency Medical Services, Inc.
- Grayson County Family Medicine, PLLC
- Grayson County Health Department
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.