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General NPI Number Information
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NPI Number | 1740273598
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Entity Type | Individual
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Provider Name | GREGORY PETER GODLESKI R.PH.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 839 W CONGRESS ST
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City | TUCSON
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State | AZ
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Zip | 85745-2819
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Country | US
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Telephone | 520-205-4996
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Fax | 520-670-3842
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Provider Business Mailing Address
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Address Line | 7502 E LESTER CIR
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City | TUCSON
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State | AZ
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Zip | 85715-4514
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Country | US
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Telephone | 520-886-7084
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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 | 11129
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License Number State | AZ
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