Provider Demographics
NPI:1003154055
Name:GOFFINETT, CAROLYN R (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:GOFFINETT
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 1:26841 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7817
Mailing Address - Country:US
Mailing Address - Phone:239-992-1675
Mailing Address - Fax:239-992-2741
Practice Address - Street 1:26841 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7817
Practice Address - Country:US
Practice Address - Phone:239-992-1675
Practice Address - Fax:239-992-2741
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0775140762Medicare NSC