Healthcare Provider Details

I. General information

NPI: 1184057259
Provider Name (Legal Business Name): GARRETT EDWARD GOODE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 EXECUTIVE CENTER DR SUITE 100
AUSTIN TX
78731-1624
US

IV. Provider business mailing address

3529 N HILLS DR APT. A
AUSTIN TX
78731-3200
US

V. Phone/Fax

Practice location:
  • Phone: 512-343-1060
  • Fax:
Mailing address:
  • Phone: 903-237-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: