Provider Demographics
NPI:1730228446
Name:GOODFELLOW, KATHRYN ANN (R PH)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:GOODFELLOW
Suffix:
Gender:F
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 1:425 MEDICAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4945
Mailing Address - Country:US
Mailing Address - Phone:801-295-3439
Mailing Address - Fax:801-299-1696
Practice Address - Street 1:425 MEDICAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4945
Practice Address - Country:US
Practice Address - Phone:801-295-3439
Practice Address - Fax:801-299-1696
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT147599-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist