Provider Demographics
NPI:1710437843
Name:GOODEN, LUKE AUSTIN
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:AUSTIN
Last Name:GOODEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-9548
Mailing Address - Country:US
Mailing Address - Phone:910-862-8517
Mailing Address - Fax:910-862-8606
Practice Address - Street 1:1347 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9548
Practice Address - Country:US
Practice Address - Phone:910-241-6158
Practice Address - Fax:910-241-6157
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist