MEDICARE: DR. SUSANNA GOODNITE RPH

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	RP0007893	WV
2	183500000X	Pharmacist	0202211379	VA

General Provider Information

NPI Number	:	1326648056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSANNA GOODNITE RPH

Provider Business Mailing Address
First Line	:	1041 HICKORY GATE RD
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24739-6823
Country	:	US
Telephone Number	:	919-619-7481
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 GREASY RIDGE RD
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24739-6900
Country	:	US
Telephone Number	:	304-431-2105
Fax Number	:	304-431-2116

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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