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General NPI Number Information
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NPI Number | 1083362685
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Entity Type | Individual
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Provider Name | KYLE GOODRICH PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2022
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Last Update Date | 03/13/2022
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Provider Practice Location Address
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Address Line | 24 S BRIDGE ST
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City | CORNING
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State | NY
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Zip | 14830-2257
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Country | US
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Telephone | 607-937-8307
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Fax |
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Provider Business Mailing Address
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Address Line | 24 S BRIDGE ST
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City | CORNING
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State | NY
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Zip | 14830-2257
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 068026
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License Number State | NY
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