Provider Demographics
NPI:1114032299
Name:GOODWIN, JERICA L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JERICA
Middle Name:L
Last Name:GOODWIN
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 1:1407 LEVEE LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-4009
Mailing Address - Country:US
Mailing Address - Phone:469-272-7998
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD # 119C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-742-8387
Practice Address - Fax:214-302-1403
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412331835P1200X
FLPS361651835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy