Provider Demographics
NPI:1346426384
Name:GOODEMOTE, KELLY K (RPH)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:K
Last Name:GOODEMOTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12167-1007
Mailing Address - Country:US
Mailing Address - Phone:607-652-3675
Mailing Address - Fax:607-652-6767
Practice Address - Street 1:5 LAKE ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:NY
Practice Address - Zip Code:12167-1007
Practice Address - Country:US
Practice Address - Phone:607-652-3675
Practice Address - Fax:607-652-6767
Is Sole Proprietor?:No
Enumeration Date:2008-01-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist