Healthcare Provider Details

I. General information

NPI: 1003955584
Provider Name (Legal Business Name): PAUL JOHN GODLEY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 THORNTON LANE SUITE A
TEMPLE TX
76502
US

IV. Provider business mailing address

1801 CANYON SPGS
BELTON TX
76513-1001
US

V. Phone/Fax

Practice location:
  • Phone: 254-742-3161
  • Fax: 254-742-3131
Mailing address:
  • Phone: 254-742-3161
  • Fax: 254-742-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number24465
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: