Individual
AMANDA MARIE GOODALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
2950 NEW PINERY RD, PORTAGE, WI 53901-9225
(608) 742-1670
(608) 742-1769
Mailing address
3072 LARSEN RD, MADISON, WI 53711-5729
(608) 333-1559
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
18793-40
WI
Other
Enumeration date
10/18/2020
Last updated
10/18/2020
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