=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154916708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER FRANKLIN GOODELL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2021
-----------------------------------------------------
Last Update Date | 03/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 WESCOTT DRIVE PHARMACY DEPT.
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-442-9478
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 WESTMINSTER PL
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822-1816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-782-4199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI01599100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------