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General NPI Number Information
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NPI Number | 1114515889
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Entity Type | Individual
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Provider Name | RONALD LANE GOOGE
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Gender | Male
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 2651 APD 40
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City | CLEVELAND
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State | TN
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Zip | 37323-0696
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Country | US
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Telephone | 423-472-2649
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 BOW ST NE
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City | CLEVELAND
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State | TN
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Zip | 37312-4802
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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 | 9722
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License Number State | TN
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