Provider Demographics
NPI:1730874827
Name:GOODRICH, CALEB JOHN (PHARMD, BCOP)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:JOHN
Last Name:GOODRICH
Suffix:
Gender:M
Credentials:PHARMD, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 OCHSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8275
Mailing Address - Country:US
Mailing Address - Phone:985-338-5028
Mailing Address - Fax:
Practice Address - Street 1:900 OCHSNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8275
Practice Address - Country:US
Practice Address - Phone:985-338-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist