Individual
KEVIN BARRIE GOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
225 MAIN ST, GREENVILLE, CA 95947-0039
(530) 284-6618
(530) 284-6940
Mailing address
PO BOX 39, GREENVILLE, CA 95947-0039
(530) 284-6618
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
9891
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C6374930
DRIVERS LICENSE
CA
Enumeration date
03/08/2007
Last updated
07/08/2007
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