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General NPI Number Information
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NPI Number | 1336769579
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Entity Type | Individual
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Provider Name | MARK J GOOD SR.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 510 WEST MCCLANE ST.
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City | OSCEOLA
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State | IA
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Zip | 50213
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Country | US
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Telephone | 641-342-2125
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 SE CRABAPPLE CT
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City | WAUKEE
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State | IA
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Zip | 50263-9550
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Country | US
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Telephone | 515-570-4106
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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 | 16564
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License Number State | IA
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