Provider Demographics
NPI:1124332259
Name:GOODPASTURE, DONNA MARGARET
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARGARET
Last Name:GOODPASTURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WENDOVER RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-2841
Mailing Address - Country:US
Mailing Address - Phone:276-466-5698
Mailing Address - Fax:
Practice Address - Street 1:1600 WENDOVER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-2841
Practice Address - Country:US
Practice Address - Phone:276-466-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18186183500000X
TN33876183500000X
VA0202011137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist