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General NPI Number Information
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NPI Number | 1558145615
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Entity Type | Individual
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Provider Name | SHELBY GOODRICH
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Gender | Female
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 9861 US HIGHWAY 64
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City | ARLINGTON
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State | TN
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Zip | 38002-7980
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Country | US
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Telephone | 901-377-8303
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Fax |
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Provider Business Mailing Address
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Address Line | 12055 S MAIN ST
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City | SOMERVILLE
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State | TN
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Zip | 38068-1618
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Country | US
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Telephone | 901-355-1590
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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 | 47453
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License Number State | TN
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