Provider Demographics
NPI:1063016277
Name:GOODNOW, DAVID ALAN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:GOODNOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3644
Mailing Address - Country:US
Mailing Address - Phone:401-884-7044
Mailing Address - Fax:401-884-3564
Practice Address - Street 1:507 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3644
Practice Address - Country:US
Practice Address - Phone:401-884-7044
Practice Address - Fax:401-884-3564
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherN/A