Provider Demographics
NPI:1962002014
Name:GOODWIN, KELLI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:GOODWIN
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 1:621 N EXPWY 77
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-5202
Mailing Address - Country:US
Mailing Address - Phone:956-507-7315
Mailing Address - Fax:956-507-7316
Practice Address - Street 1:621 N EXPWY 77
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-5202
Practice Address - Country:US
Practice Address - Phone:956-507-7315
Practice Address - Fax:956-507-7316
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist