Provider Demographics
NPI:1962564625
Name:GODLEWSKI, ANTHONY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:GODLEWSKI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-0366
Mailing Address - Country:US
Mailing Address - Phone:909-427-3823
Mailing Address - Fax:909-427-3830
Practice Address - Street 1:9310 SIERRA AVE
Practice Address - Street 2:PHARMACY ADMINSITRATION OFFICE
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5711
Practice Address - Country:US
Practice Address - Phone:909-427-3823
Practice Address - Fax:909-427-3830
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 46611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist