Healthcare Provider Details

I. General information

NPI: 1033404678
Provider Name (Legal Business Name): AMY GOODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 06/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 COLERAIN AVE T1545
CINCINNATI OH
45251-2402
US

IV. Provider business mailing address

9040 COLERAIN AVE T1545
CINCINNATI OH
45251-2402
US

V. Phone/Fax

Practice location:
  • Phone: 513-719-0038
  • Fax: 513-719-0038
Mailing address:
  • Phone: 513-719-0038
  • Fax: 513-719-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03124796
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: