Provider Demographics
NPI:1386230092
Name:GOOD, KELLY LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:GOOD
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 1:3887 ELMORE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2504
Mailing Address - Country:US
Mailing Address - Phone:563-344-4232
Mailing Address - Fax:563-344-4744
Practice Address - Street 1:3887 ELMORE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2504
Practice Address - Country:US
Practice Address - Phone:563-344-4232
Practice Address - Fax:563-344-4744
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist