Provider Demographics
NPI:1811229081
Name:GODLEWSKI, MARYANNE (RPH)
Entity type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:
Last Name:GODLEWSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:MARYANNE
Other - Middle Name:GODLEWSKI
Other - Last Name:VAGNINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:10 BLACKSMITH DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4428
Mailing Address - Country:US
Mailing Address - Phone:518-899-8103
Mailing Address - Fax:518-899-2968
Practice Address - Street 1:10 BLACKSMITH DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4428
Practice Address - Country:US
Practice Address - Phone:518-899-8103
Practice Address - Fax:518-899-2968
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist