# GOODWATER PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GOODWATER PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154425106
- **Authorized official:** RICHARD COLLINS RPH (PRESIDENT)
- **Authorized official phone:** (256) 839-6361

## Contact information

- **Practice address:** 21338 AL HIGHWAY 9, GOODWATER, AL 35072-6621
- **Practice address phone:** (256) 839-6361
- **Practice address fax:** (256) 839-6481
- **Mailing address:** PO BOX 48, GOODWATER, AL 35072-0048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 112684 | AL | Yes |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 01/13/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100003637 | — | AL |
| 01 | — | 1995706 | PK | — |