Provider Demographics
NPI:1154127132
Name:GOODSON PHARMACY
Entity type:Organization
Organization Name:GOODSON PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-265-2020
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-265-2987
Practice Address - Street 1:159 HIGHWAY 53 W
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-3415
Practice Address - Country:US
Practice Address - Phone:706-265-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy