Healthcare Provider Details

I. General information

NPI: 1053447284
Provider Name (Legal Business Name): PAIGE M GOODWIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12040 NE 128TH ST
KIRKLAND WA
98034-3013
US

IV. Provider business mailing address

17756 NE 90TH ST APT N272
REDMOND WA
98052-3256
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-2790
  • Fax:
Mailing address:
  • Phone: 801-809-3343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00066844
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5032945-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: