MEDICARE: RONALD LANE GOOGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	9722	TN

General Provider Information

NPI Number	:	1114515889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD LANE GOOGE

Provider Business Mailing Address
First Line	:	3825 BOW ST NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2651 APD 40
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-0696
Country	:	US
Telephone Number	:	423-472-2649
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	01/07/2021

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Directions to “ RONALD LANE GOOGE ” Practice Location

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