Provider Demographics
NPI:1710437843
Name:GOODEN, LUKE
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:
Last Name:GOODEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ODOM ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384
Mailing Address - Country:US
Mailing Address - Phone:910-241-6158
Mailing Address - Fax:910-241-6157
Practice Address - Street 1:120 ODOM ROAD
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384
Practice Address - Country:US
Practice Address - Phone:910-241-6158
Practice Address - Fax:910-241-6157
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist