MEDICARE: JADA MAKEL GOODEN 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	RP00009736	NM

General Provider Information

NPI Number	:	1528789112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADA MAKEL GOODEN RPH

Provider Business Mailing Address
First Line	:	855 E UNIVERSITY AVE APT 637
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-6615
Country	:	US
Telephone Number	:	575-791-9691
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 S WALNUT ST STE A5
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2613
Country	:	US
Telephone Number	:	575-288-1412
Fax Number	:

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

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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Directions to “ JADA MAKEL GOODEN RPH” Practice Location

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