MEDICARE: KELLY LYNN GOOD PHARMD

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	20294	IA

General Provider Information

NPI Number	:	1386230092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LYNN GOOD PHARMD

Provider Business Mailing Address
First Line	:	3887 ELMORE AVE
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2504
Country	:	US
Telephone Number	:	563-344-4232
Fax Number	:	563-344-4744

Provider Business Practice Location Address
First Line	:	3887 ELMORE AVE
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2504
Country	:	US
Telephone Number	:	563-344-4232
Fax Number	:	563-344-4744

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

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/16/2020

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