Healthcare Provider Details

I. General information

NPI: 1033111828
Provider Name (Legal Business Name): SUSAN LEA GOE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH ST
HOOD RIVER OR
97031-1204
US

IV. Provider business mailing address

3584 WYEAST RD
HOOD RIVER OR
97031-9429
US

V. Phone/Fax

Practice location:
  • Phone: 541-387-6338
  • Fax: 541-387-8213
Mailing address:
  • Phone: 354-354-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6518
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: