Provider Demographics
NPI:1770628315
Name:GOODMAN, HOWELL STEWART SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:HOWELL
Middle Name:STEWART
Last Name:GOODMAN
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-0027
Mailing Address - Country:US
Mailing Address - Phone:850-674-5013
Mailing Address - Fax:850-674-4568
Practice Address - Street 1:17324 MAIN STREET NORTH
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424
Practice Address - Country:US
Practice Address - Phone:850-674-4557
Practice Address - Fax:850-674-4568
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 15408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist