Provider Demographics
NPI:1043767056
Name:GOEING, MICHAEL STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:GOEING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 KY ROUTE 306
Mailing Address - Street 2:
Mailing Address - City:BYPRO
Mailing Address - State:KY
Mailing Address - Zip Code:41612-9711
Mailing Address - Country:US
Mailing Address - Phone:606-452-4134
Mailing Address - Fax:606-452-4211
Practice Address - Street 1:107 KY ROUTE 306
Practice Address - Street 2:
Practice Address - City:BYPRO
Practice Address - State:KY
Practice Address - Zip Code:41612-9711
Practice Address - Country:US
Practice Address - Phone:606-452-4134
Practice Address - Fax:606-452-4211
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100324200Medicaid