Provider Demographics
NPI:1750663100
Name:GOODMAN DRUG COMPANY PLLC
Entity Type:Organization
Organization Name:GOODMAN DRUG COMPANY PLLC
Other - Org Name:GOODMAN DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-323-0111
Mailing Address - Street 1:1109 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-2040
Mailing Address - Country:US
Mailing Address - Phone:870-857-0551
Mailing Address - Fax:870-857-0554
Practice Address - Street 1:1109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-2040
Practice Address - Country:US
Practice Address - Phone:870-857-0551
Practice Address - Fax:870-857-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR206653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131677OtherPK