Provider Demographics
NPI:1477066603
Name:GOODE, KIMBERLY WARD (RPH, BCGP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WARD
Last Name:GOODE
Suffix:
Gender:F
Credentials:RPH, BCGP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:CALILUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:9404 FALLING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HUDDLESTON
Mailing Address - State:VA
Mailing Address - Zip Code:24104-3818
Mailing Address - Country:US
Mailing Address - Phone:540-330-3836
Mailing Address - Fax:
Practice Address - Street 1:9404 FALLING CREEK RD
Practice Address - Street 2:
Practice Address - City:HUDDLESTON
Practice Address - State:VA
Practice Address - Zip Code:24104-3818
Practice Address - Country:US
Practice Address - Phone:540-330-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020101281835G0303X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric