Provider Demographics
NPI:1881986495
Name:GOODMAN, ALICE JANIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:JANIE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:JANIE
Other - Last Name:MURISET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:750 WHITNEY PASS
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-7500
Mailing Address - Country:US
Mailing Address - Phone:706-399-8094
Mailing Address - Fax:
Practice Address - Street 1:750 WHITNEY PASS
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-7500
Practice Address - Country:US
Practice Address - Phone:706-399-8094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42814183500000X
GARPH024273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist