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General NPI Number Information
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NPI Number | 1952695157
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Entity Type | Individual
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Provider Name | STEPHEN SCOTT GODDU R.PH.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 520 MAIN ST
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City | FALMOUTH
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State | MA
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Zip | 02540-3129
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Country | US
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Telephone | 508-495-2991
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Fax | 508-495-2988
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Provider Business Mailing Address
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Address Line | 10 NANCY LN
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City | MASHPEE
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State | MA
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Zip | 02649-3444
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Country | US
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Telephone | 508-539-2162
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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 | PH21395
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License Number State | MA
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