Provider Demographics
NPI:1144823550
Name:GOETZINGER, JEFFEY JOHN (R PH)
Entity type:Individual
Prefix:MR
First Name:JEFFEY
Middle Name:JOHN
Last Name:GOETZINGER
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 S HILLSBORO AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4862
Mailing Address - Country:US
Mailing Address - Phone:417-350-8912
Mailing Address - Fax:
Practice Address - Street 1:3816 W CHESTNUT EXPY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-5500
Practice Address - Country:US
Practice Address - Phone:417-868-8288
Practice Address - Fax:417-868-8248
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist