Provider Demographics
NPI:1205469822
Name:GOODLETT, MARY KATHRYN (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:GOODLETT
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 1:4172 RESERVE RD APT 204
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-4071
Mailing Address - Country:US
Mailing Address - Phone:859-612-7775
Mailing Address - Fax:
Practice Address - Street 1:844 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2140
Practice Address - Country:US
Practice Address - Phone:859-734-0081
Practice Address - Fax:859-734-0084
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0206881835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist