Provider Demographics
NPI:1528347986
Name:GOODWILL, SCOTT STEPHEN (PHARMD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:STEPHEN
Last Name:GOODWILL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 TWIN PONDS RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-6934
Mailing Address - Country:US
Mailing Address - Phone:814-706-2753
Mailing Address - Fax:
Practice Address - Street 1:814 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-3535
Practice Address - Country:US
Practice Address - Phone:864-984-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist