Provider Demographics
NPI:1356658496
Name:GOODWIN, GREG (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 CASTLEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7954
Mailing Address - Country:US
Mailing Address - Phone:513-535-5722
Mailing Address - Fax:
Practice Address - Street 1:5156 CASTLEBROOK CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7954
Practice Address - Country:US
Practice Address - Phone:513-535-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124716183500000X
KY012435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist