Healthcare Provider Details

I. General information

NPI: 1417246299
Provider Name (Legal Business Name): GOODWILL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 WILMINGTON RD # 100
NEW CASTLE PA
16105-1537
US

IV. Provider business mailing address

2602 WILMINGTON RD # 100
NEW CASTLE PA
16105-1537
US

V. Phone/Fax

Practice location:
  • Phone: 724-202-6297
  • Fax:
Mailing address:
  • Phone: 724-202-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482104
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAMPRAKASH NARAYANAKUMAR
Title or Position: DIRECTOR
Credential:
Phone: 724-202-6297