Provider Demographics
NPI:1063140903
Name:GOODWIN, ALEXANDER THOMAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:THOMAS
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PROPHETSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61277-1184
Mailing Address - Country:US
Mailing Address - Phone:815-537-2400
Mailing Address - Fax:815-537-2404
Practice Address - Street 1:316 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PROPHETSTOWN
Practice Address - State:IL
Practice Address - Zip Code:61277-1184
Practice Address - Country:US
Practice Address - Phone:815-537-2400
Practice Address - Fax:815-537-2404
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.304322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist