Provider Demographics
NPI:1821234451
Name:GOAD, GARY ANDREW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ANDREW
Last Name:GOAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 PRIVATE DRIVE 10467
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-7886
Mailing Address - Country:US
Mailing Address - Phone:740-451-0816
Mailing Address - Fax:
Practice Address - Street 1:445 PRIVATE DRIVE 10467
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-7886
Practice Address - Country:US
Practice Address - Phone:740-451-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-03
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist