MEDICARE: MR. HARRY GODLEWSKI JR. R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302024946	MI

General Provider Information

NPI Number	:	1003192485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HARRY GODLEWSKI JR. R.PH.

Provider Business Mailing Address
First Line	:	18030 EDGEFIELD DR
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-2425
Country	:	US
Telephone Number	:	586-933-7259
Fax Number	:

Provider Business Practice Location Address
First Line	:	51200 WASHINGTON ST
Second Line	:
City	:	NEW BALTIMORE
State	:	MI
Zip	:	48047-1563
Country	:	US
Telephone Number	:	586-716-3187
Fax Number	:	586-716-3204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2011
Last Update Date	:	10/28/2011

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