Healthcare Provider Details

I. General information

NPI: 1538470323
Provider Name (Legal Business Name): KRISTY LEANN GOAD-BOYD PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 MCARTHUR ST
MANCHESTER TN
37355-2324
US

IV. Provider business mailing address

806 MCARTHUR ST
MANCHESTER TN
37355-2324
US

V. Phone/Fax

Practice location:
  • Phone: 931-728-0874
  • Fax: 931-728-7318
Mailing address:
  • Phone: 931-728-0874
  • Fax: 931-728-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000031061
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: