Provider Demographics
NPI:1831113729
Name:GOODE, THOMAS LAFAYETTE (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LAFAYETTE
Last Name:GOODE
Suffix:
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 1:112 HILDA CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4723
Mailing Address - Country:US
Mailing Address - Phone:757-826-7955
Mailing Address - Fax:
Practice Address - Street 1:2501 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4636
Practice Address - Country:US
Practice Address - Phone:757-247-9554
Practice Address - Fax:757-247-6715
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00202004565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist