Provider Demographics
NPI:1841883477
Name:GOODIN, ALBERT HENRY SR (RPH)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:HENRY
Last Name:GOODIN
Suffix:SR
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 1:5456 NW COMER ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4013
Mailing Address - Country:US
Mailing Address - Phone:772-577-1210
Mailing Address - Fax:
Practice Address - Street 1:281 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5045
Practice Address - Country:US
Practice Address - Phone:772-340-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist