=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659982247
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTORIA GOODMAN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2020
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1778 HIGHWAY 1 S
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38701-7801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-332-0231
-----------------------------------------------------
Fax | 662-332-0232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2059 BRANCH CREEK DR
-----------------------------------------------------
City | BYRAM
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39272-8953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-927-0805
-----------------------------------------------------
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 | E-16591
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------