Provider Demographics
NPI:1154916708
Name:GOODELL, PETER FRANKLIN
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:FRANKLIN
Last Name:GOODELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1816
Mailing Address - Country:US
Mailing Address - Phone:908-782-4199
Mailing Address - Fax:
Practice Address - Street 1:2100 WESCOTT DRIVE
Practice Address - Street 2:PHARMACY DEPT.
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-442-9478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01599100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist