Healthcare Provider Details

I. General information

NPI: 1952071045
Provider Name (Legal Business Name): NANCY GOODBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

IV. Provider business mailing address

2546 HIGHWAY 56 S
CLINTON SC
29325-6846
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-4134
  • Fax: 864-725-4139
Mailing address:
  • Phone: 864-426-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12107
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: