Healthcare Provider Details

I. General information

NPI: 1629900295
Provider Name (Legal Business Name): JEANNE GOODBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E HARDY ST
INGLEWOOD CA
90301-4011
US

IV. Provider business mailing address

2300 MAPLE AVE APT 194
TORRANCE CA
90503-7149
US

V. Phone/Fax

Practice location:
  • Phone: 310-419-8688
  • Fax:
Mailing address:
  • Phone: 310-416-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH43549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: