Provider Demographics
NPI:1831668599
Name:GOODHART, DONNA (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GOODHART
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 1:2726 N HARTLAND CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-9263
Mailing Address - Country:US
Mailing Address - Phone:312-659-4475
Mailing Address - Fax:
Practice Address - Street 1:2338 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3423
Practice Address - Country:US
Practice Address - Phone:773-360-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist