Provider Demographics
NPI:1184057259
Name:GOODE, GARRETT EDWARD (PHARMD)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:EDWARD
Last Name:GOODE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 N HILLS DR
Mailing Address - Street 2:APT. A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3200
Mailing Address - Country:US
Mailing Address - Phone:903-237-8621
Mailing Address - Fax:
Practice Address - Street 1:3420 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1624
Practice Address - Country:US
Practice Address - Phone:512-343-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist