Provider Demographics
NPI:1801221684
Name:GOODWIN, KATHRYN CASEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CASEY
Last Name:GOODWIN
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 1:99 COVERED BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-2076
Mailing Address - Country:US
Mailing Address - Phone:302-731-0172
Mailing Address - Fax:
Practice Address - Street 1:401 GOVERNORS PL
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3032
Practice Address - Country:US
Practice Address - Phone:302-834-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004078183500000X
MD19921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist