Provider Demographics
NPI:1184258600
Name:GOOD, PATRICK JOESPH (RPH)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOESPH
Last Name:GOOD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 PENNSYLVANIA AVE # 8
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4537
Mailing Address - Country:US
Mailing Address - Phone:304-345-8600
Mailing Address - Fax:304-345-8602
Practice Address - Street 1:3212 PENNSYLVANIA AVE # 8
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-4537
Practice Address - Country:US
Practice Address - Phone:304-345-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist