Healthcare Provider Details

I. General information

NPI: 1932171048
Provider Name (Legal Business Name): GEORGE GOODREAU
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 FRANKLIN AVE
LEMOORE CA
93246-0001
US

IV. Provider business mailing address

460 MEADOW GLEN DR
FALLON NV
89406-5746
US

V. Phone/Fax

Practice location:
  • Phone: 559-998-4262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS27868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: