Provider Demographics
NPI:1790282333
Name:GOODE, PAMELA TRASK (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:TRASK
Last Name:GOODE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-9716
Mailing Address - Country:US
Mailing Address - Phone:515-989-3261
Mailing Address - Fax:515-989-4140
Practice Address - Street 1:800 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-9716
Practice Address - Country:US
Practice Address - Phone:515-989-3261
Practice Address - Fax:515-989-4140
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist