MEDICARE: MR. JAMES DAVID GOODMAN R.PH.

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	R06513	MS

General Provider Information

NPI Number	:	1255609269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES DAVID GOODMAN R.PH.

Provider Business Mailing Address
First Line	:	526 ROBINSON DR
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2214
Country	:	US
Telephone Number	:	662-843-1810
Fax Number	:	662-846-2999

Provider Business Practice Location Address
First Line	:	526 ROBINSON DR
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2214
Country	:	US
Telephone Number	:	662-843-1810
Fax Number	:	662-846-2999

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

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	12/05/2011

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Directions to “ MR. JAMES DAVID GOODMAN R.PH.” Practice Location

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