Provider Demographics
NPI:1730583287
Name:GOODSPEED, KATE (BS, MA, PHARMD)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:GOODSPEED
Suffix:
Gender:F
Credentials:BS, MA, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2252
Mailing Address - Country:US
Mailing Address - Phone:210-738-2414
Mailing Address - Fax:
Practice Address - Street 1:3401 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2252
Practice Address - Country:US
Practice Address - Phone:210-738-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX55500OtherTSBP LICENSE
TX183500000XOtherTAXONOMY