Provider Demographics
NPI:1528161510
Name:GOODHEART, RONALD L (RPH)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:L
Last Name:GOODHEART
Suffix:
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 1:333 WATER ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:ME
Mailing Address - Zip Code:04346-5335
Mailing Address - Country:US
Mailing Address - Phone:207-623-8411
Mailing Address - Fax:207-621-4843
Practice Address - Street 1:ONE VA DRIVE
Practice Address - Street 2:VA HOSPITAL
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-621-4843
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist