Provider Demographics
NPI:1508437294
Name:GOENNER, JOHN GILBERT (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GILBERT
Last Name:GOENNER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 HIGHWAY 25 N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1920
Mailing Address - Country:US
Mailing Address - Phone:763-682-6354
Mailing Address - Fax:
Practice Address - Street 1:1002 HIGHWAY 25 N
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1920
Practice Address - Country:US
Practice Address - Phone:763-682-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist