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General NPI Number Information
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NPI Number | 1437376092
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Entity Type | Individual
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Provider Name | SCOTT ERROL GOODMANSON RPH
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2708 BRIDGE AVE
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City | ALBERT LEA
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State | MN
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Zip | 56007-2077
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Country | US
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Telephone | 507-373-1899
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 CRESTVIEW RD
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City | ALBERT LEA
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State | MN
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Zip | 56007-3542
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Country | US
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Telephone | 507-373-8629
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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 | 111775
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License Number State | MN
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