Provider Demographics
NPI:1407921943
Name:CORPORATE HEALTH DIMENSIONS, INC.
Entity Type:Organization
Organization Name:CORPORATE HEALTH DIMENSIONS, INC.
Other - Org Name:GOODYEAR FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BICE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:1615-665-9500
Mailing Address - Street 1:40 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6155
Mailing Address - Country:US
Mailing Address - Phone:161-566-5950
Mailing Address - Fax:
Practice Address - Street 1:851 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1133
Practice Address - Country:US
Practice Address - Phone:125-649-2659
Practice Address - Fax:125-649-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1027903336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy