Provider Demographics
NPI:1932757564
Name:GOSHORN, EMILY SUZANNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SUZANNE
Last Name:GOSHORN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 GRANITE SPRING DR
Mailing Address - Street 2:
Mailing Address - City:COLD SPRGS HIGHLAND HTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-7103
Mailing Address - Country:US
Mailing Address - Phone:859-380-6253
Mailing Address - Fax:
Practice Address - Street 1:6711 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-1025
Practice Address - Country:US
Practice Address - Phone:859-635-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist