=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649874348
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIE GOODSON PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2020
-----------------------------------------------------
Last Update Date | 11/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2058 US HIGHWAY 45 BYP S
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38382-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-855-2171
-----------------------------------------------------
Fax | 731-855-4123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 VISTAVIEW CV
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38305-6700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-315-1179
-----------------------------------------------------
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 | 37607
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------