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General NPI Number Information
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NPI Number | 1801187992
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Entity Type | Individual
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Provider Name | J DAVID GOODLAXSON R.PH.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 3033 LINCOLN PARK DR
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City | GALESBURG
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State | IL
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Zip | 61401-1127
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Country | US
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Telephone | 309-344-2814
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Fax | 309-344-2814
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Provider Business Mailing Address
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Address Line | PO BOX 425
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City | GALESBURG
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State | IL
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Zip | 61402-0425
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Country | US
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Telephone | 309-344-2814
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Fax | 309-344-2814
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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 | 051030187
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License Number State | IL
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