Provider Demographics
NPI:1417246299
Name:GOODWILL PHARMACY INC
Entity Type:Organization
Organization Name:GOODWILL PHARMACY INC
Other - Org Name:GOODWILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMPRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAYANAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-202-6297
Mailing Address - Street 1:2602 WILMINGTON RD
Mailing Address - Street 2:# 100
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1537
Mailing Address - Country:US
Mailing Address - Phone:724-202-6297
Mailing Address - Fax:
Practice Address - Street 1:2602 WILMINGTON RD
Practice Address - Street 2:# 100
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1537
Practice Address - Country:US
Practice Address - Phone:724-202-6297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4821043336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3995240OtherNCPDP PROVIDER IDENTIFICATION NUMBER