Provider Demographics
NPI:1043425556
Name:GOECKNER, MARSHA D (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:D
Last Name:GOECKNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28491 OLD SPIRAL HWY
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5064
Mailing Address - Country:US
Mailing Address - Phone:208-305-9698
Mailing Address - Fax:
Practice Address - Street 1:338 6TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2419
Practice Address - Country:US
Practice Address - Phone:208-848-8290
Practice Address - Fax:208-848-8291
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist