Provider Demographics
NPI:1649874348
Name:GOODSON, KATIE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GOODSON
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 1:49 VISTAVIEW CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6700
Mailing Address - Country:US
Mailing Address - Phone:386-315-1179
Mailing Address - Fax:
Practice Address - Street 1:2058 US HIGHWAY 45 BYP S
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-3507
Practice Address - Country:US
Practice Address - Phone:731-855-2171
Practice Address - Fax:731-855-4123
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist