Provider Demographics
NPI:1528669025
Name:GOODLICK, AMY JO (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:GOODLICK
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 1:1530 WALMART DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7342
Mailing Address - Country:US
Mailing Address - Phone:513-932-6210
Mailing Address - Fax:513-932-6431
Practice Address - Street 1:1530 WALMART DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7342
Practice Address - Country:US
Practice Address - Phone:513-932-6210
Practice Address - Fax:513-932-6431
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019622A183500000X
OH03323961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist