=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184057259
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARRETT EDWARD GOODE PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2013
-----------------------------------------------------
Last Update Date | 08/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3420 EXECUTIVE CENTER DR SUITE 100
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78731-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-343-1060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3529 N HILLS DR APT. A
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78731-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-237-8621
-----------------------------------------------------
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 | 53666
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------