Healthcare Provider Details

I. General information

NPI: 1124234943
Provider Name (Legal Business Name): CHRISTINA MARIE GODWIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

9827 S LONGWOOD DR
CHICAGO IL
60643-1705
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-1312
  • Fax: 312-996-8525
Mailing address:
  • Phone: 773-233-3449
  • Fax: 773-429-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: