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General NPI Number Information
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NPI Number | 1588715064
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Entity Type | Individual
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Provider Name | KENDALL R. GOETZ R.PH.
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Gender | Male
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 815 1ST AVE SE
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City | ABERDEEN
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State | SD
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Zip | 57401-4602
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Country | US
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Telephone | 605-225-1945
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Fax | 605-725-0037
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Provider Business Mailing Address
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Address Line | 1316 18TH AVE NE
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City | ABERDEEN
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State | SD
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Zip | 57401-1537
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Country | US
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Telephone | 605-229-0872
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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 | 4806
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License Number State | SD
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