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General NPI Number Information
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NPI Number | 1861591505
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Entity Type | Organization
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Legal Business Name | GOES HEALTH LLC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 572 MIDDLEBURY RD
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City | MIDDLEBURY
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State | CT
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Zip | 06762-2553
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Country | US
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Telephone | 203-758-1220
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Fax | 203-598-0178
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Provider Business Mailing Address
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Address Line | 572 MIDDLEBURY RD
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City | MIDDLEBURY
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State | CT
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Zip | 06762-2553
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Country | US
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Telephone | 203-758-1220
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Fax | 203-598-0178
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Authorized Official
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Title or Position | MANAGER
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Name | GARY OUELLETTE
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Credential | RPH
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Telephone | 203-758-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1822
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License Number State | CT
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