Provider Demographics
NPI:1558814269
Name:GOODWIN, STEPHANIE AMBER (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:AMBER
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:AMBER
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 323
Mailing Address - Street 2:
Mailing Address - City:LYNDON CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05850
Mailing Address - Country:US
Mailing Address - Phone:802-274-9027
Mailing Address - Fax:
Practice Address - Street 1:412 BROAD STREET
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851
Practice Address - Country:US
Practice Address - Phone:802-626-4366
Practice Address - Fax:802-626-4370
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234363183500000X
VT033.0117592183500000X
RIRPH05115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist