Provider Demographics
NPI:1366288045
Name:GOOD, REGGINALD TAVARUS SMITH (PHARMD)
Entity type:Individual
Prefix:
First Name:REGGINALD
Middle Name:TAVARUS SMITH
Last Name:GOOD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-2859
Mailing Address - Country:US
Mailing Address - Phone:601-597-4042
Mailing Address - Fax:
Practice Address - Street 1:2801 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6655
Practice Address - Country:US
Practice Address - Phone:318-387-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.025068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist