Provider Demographics
NPI:1912342254
Name:GOODWIN, MALCOLM N III (PHARMD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:N
Last Name:GOODWIN
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 COLTSFOOT CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7223
Mailing Address - Country:US
Mailing Address - Phone:864-322-3610
Mailing Address - Fax:
Practice Address - Street 1:205 COLTSFOOT CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7223
Practice Address - Country:US
Practice Address - Phone:864-322-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11781183500000X
NC22785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist