Provider Demographics
NPI:1326273434
Name:GOODIS, SUSAN HELENE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HELENE
Last Name:GOODIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:408 ALPINE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3736
Mailing Address - Country:US
Mailing Address - Phone:412-372-5288
Mailing Address - Fax:412-374-9089
Practice Address - Street 1:4111 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2601
Practice Address - Country:US
Practice Address - Phone:412-372-5288
Practice Address - Fax:412-374-9089
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031764L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist