Provider Demographics
NPI:1528789112
Name:GOODEN, JADA MAKEL (RPH)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:MAKEL
Last Name:GOODEN
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 1:855 E UNIVERSITY AVE APT 637
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6615
Mailing Address - Country:US
Mailing Address - Phone:575-791-9691
Mailing Address - Fax:
Practice Address - Street 1:151 S WALNUT ST STE A5
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2613
Practice Address - Country:US
Practice Address - Phone:575-288-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist