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General NPI Number Information
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NPI Number | 1518034685
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Entity Type | Individual
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Provider Name | GARRY L GODDETTE R.PH.
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Gender | Male
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 444 N 44TH ST STE 400
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City | PHOENIX
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State | AZ
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Zip | 85008-7629
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Country | US
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Telephone | 602-629-1584
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Fax | 602-914-5906
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Provider Business Mailing Address
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Address Line | 404 S PORT DR
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City | GILBERT
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State | AZ
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Zip | 85233-6715
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Country | US
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Telephone | 404-275-5571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14661
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP043822R
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5216
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License Number State | CT
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