Jacqueline Diane Goodkin, PHARM.D.
Individual provider Active NPI Pharmacotherapy Pharmacist · Fargp, ND
NPI 1891898136 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1891898136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacotherapy Pharmacist 1835P1200X
- License
- 3023 (ND)
- Practice address
- 2101 Elm St N
Fargp, ND 58102 - Phone
- (701) 239-3700
- NPI assigned
- Sep 5, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3023 | ND | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 3023 | ND | Yes |
Addresses
Primary practice location
2101 Elm St N
Fargp, ND 58102
Mailing address
1454 River Rd S
Fargo, ND 58103-4325
Phone (701) 239-3700
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.