Provider Demographics
NPI:1457606824
Name:GOBLE, ADRIENNE JILL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:JILL
Last Name:GOBLE
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 1:101 NORTH MAIN ST
Mailing Address - Street 2:PO BOX 125
Mailing Address - City:LICKING
Mailing Address - State:MO
Mailing Address - Zip Code:65542
Mailing Address - Country:US
Mailing Address - Phone:573-674-3932
Mailing Address - Fax:573-674-4334
Practice Address - Street 1:101 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:LICKING
Practice Address - State:MO
Practice Address - Zip Code:65542-9026
Practice Address - Country:US
Practice Address - Phone:573-674-3932
Practice Address - Fax:573-674-4334
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist