Provider Demographics
NPI:1891194429
Name:GOODMAN, ALLISON CAROLINE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:CAROLINE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:CAROLINE
Other - Last Name:CONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17672 HOLLY OAK AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5141
Mailing Address - Country:US
Mailing Address - Phone:610-739-6974
Mailing Address - Fax:
Practice Address - Street 1:12550 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-7979
Practice Address - Country:US
Practice Address - Phone:239-482-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist