Provider Demographics
NPI:1770645293
Name:GOODWIN, DAWN R (RPH)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:FORT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-8059
Mailing Address - Country:US
Mailing Address - Phone:419-375-2323
Mailing Address - Fax:419-375-4488
Practice Address - Street 1:102 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:FORT RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846-8059
Practice Address - Country:US
Practice Address - Phone:419-375-2323
Practice Address - Fax:419-375-4488
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0301227893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy