Provider Demographics
NPI:1336691500
Name:GOFFREDO, LYNNETTE
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:GOFFREDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HOTEL LN
Mailing Address - Street 2:
Mailing Address - City:UNION DALE
Mailing Address - State:PA
Mailing Address - Zip Code:18470-7910
Mailing Address - Country:US
Mailing Address - Phone:570-561-7206
Mailing Address - Fax:
Practice Address - Street 1:54 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1927
Practice Address - Country:US
Practice Address - Phone:570-282-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI010251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist