Healthcare Provider Details

I. General information

NPI: 1477066603
Provider Name (Legal Business Name): KIMBERLY WARD GOODE RPH, BCGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY ANNE CALILUNG RPH

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9404 FALLING CREEK RD
HUDDLESTON VA
24104-3818
US

IV. Provider business mailing address

9404 FALLING CREEK RD
HUDDLESTON VA
24104-3818
US

V. Phone/Fax

Practice location:
  • Phone: 540-330-3836
  • Fax:
Mailing address:
  • Phone: 540-330-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number0202010128
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202010128
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: