Healthcare Provider Details

I. General information

NPI: 1437144474
Provider Name (Legal Business Name): HEIDI K. GOODEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 W PIERCE ST
CARLSBAD NM
88220-3568
US

IV. Provider business mailing address

805 TUSCANY LANE
CARLSBAD NM
88220
US

V. Phone/Fax

Practice location:
  • Phone: 505-885-2979
  • Fax: 505-885-5714
Mailing address:
  • Phone: 505-885-9196
  • Fax: 505-885-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4643
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: