Provider Demographics
NPI:1063000982
Name:GOODWIN, ROBERT PAUL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-6256
Mailing Address - Country:US
Mailing Address - Phone:727-841-8205
Mailing Address - Fax:
Practice Address - Street 1:3511 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-6256
Practice Address - Country:US
Practice Address - Phone:727-841-8205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL61685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist