Provider Demographics
NPI:1194927178
Name:GOODSON, GREGORY LARKIN (NRPH)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LARKIN
Last Name:GOODSON
Suffix:
Gender:M
Credentials:NRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322-0154
Mailing Address - Country:US
Mailing Address - Phone:334-347-2449
Mailing Address - Fax:334-393-0206
Practice Address - Street 1:612 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1775
Practice Address - Country:US
Practice Address - Phone:334-393-0086
Practice Address - Fax:334-393-0206
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL105531835N0905X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear