Healthcare Provider Details

I. General information

NPI: 1033409693
Provider Name (Legal Business Name): DINA MOUTOS GOODSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 MORGANTON RD
FAYETTEVILLE NC
28303-4963
US

IV. Provider business mailing address

316 VALLEY RD
FAYETTEVILLE NC
28305-5227
US

V. Phone/Fax

Practice location:
  • Phone: 910-868-5103
  • Fax: 910-868-9719
Mailing address:
  • Phone: 910-486-9394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11340
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: