Provider Demographics
NPI:1790378198
Name:GOODPASTER, AMY (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GOODPASTER
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 1:6695 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-1653
Mailing Address - Country:US
Mailing Address - Phone:407-810-3441
Mailing Address - Fax:
Practice Address - Street 1:2508 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2646
Practice Address - Country:US
Practice Address - Phone:814-452-5446
Practice Address - Fax:814-452-7842
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4470021835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology