Provider Demographics
NPI:1891794756
Name:GOODE, JEAN-VENABLE ROBERTSON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-VENABLE
Middle Name:ROBERTSON
Last Name:GOODE
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:PO BOX 980533
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0533
Mailing Address - Country:US
Mailing Address - Phone:804-828-3865
Mailing Address - Fax:804-828-8359
Practice Address - Street 1:410 N 12TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5062
Practice Address - Country:US
Practice Address - Phone:804-828-3865
Practice Address - Fax:804-828-8359
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020200097691835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy