Provider Demographics
NPI:1427486034
Name:GOODING, TERESA L (RPH)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:GOODING
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 1:1703 ELM STREET WEST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924
Mailing Address - Country:US
Mailing Address - Phone:803-943-0683
Mailing Address - Fax:803-943-0783
Practice Address - Street 1:1703 ELM STREE WEST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924
Practice Address - Country:US
Practice Address - Phone:803-943-0683
Practice Address - Fax:803-943-0783
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist