Provider Demographics
NPI:1750423331
Name:GOODMAN, CLIFFORD DOWLING II (RPH)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:DOWLING
Last Name:GOODMAN
Suffix:II
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 1:17324 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-1763
Mailing Address - Country:US
Mailing Address - Phone:850-674-8429
Mailing Address - Fax:
Practice Address - Street 1:17324 MAIN ST N
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1763
Practice Address - Country:US
Practice Address - Phone:850-674-4557
Practice Address - Fax:850-674-4568
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS12630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist