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NPI Code Detail

MEDICARE: MR. ERIC JAMES GOODSON R.PH.

MEDICARE:  MR. ERIC JAMES GOODSON  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
1183500000XPharmacist26014746AIN

General Provider Information

NPI Number : 1457633315
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC JAMES GOODSON R.PH.
Provider Business Mailing Address
First Line : 1816 FRANKLIN ST
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-4504
Country : US
Telephone Number : 219-874-2544
Fax Number :
Provider Business Practice Location Address
First Line : 1816 FRANKLIN ST
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-4504
Country : US
Telephone Number : 219-874-2544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2011
Last Update Date : 09/15/2011

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Directions to “ MR. ERIC JAMES GOODSON R.PH.” Practice Location

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