Provider Demographics
NPI:1356313803
Name:GOODWIN, BARBARA A (RPH,MS)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:A
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:RPH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1416
Mailing Address - Country:US
Mailing Address - Phone:912-655-9080
Mailing Address - Fax:
Practice Address - Street 1:1094 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5437
Practice Address - Country:US
Practice Address - Phone:843-524-3777
Practice Address - Fax:843-524-3776
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4223436183500000X
SC3420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1808Medicaid
SC571089983OtherTAX IDENTIFICATION NUMBER