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Organization
LEROY M GODFREY
Active
Organization
LEROY M GODFREY
Active
Other names
GODFREYS GARIBALDI PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LEROY GODFREY RPH (OWNER)
(503) 322-3456
Entity
Organization
Contact information
Practice address
510 GARIBALDI AVE, GARIBALDI, OR 97118-1513
(503) 322-3456
(503) 322-0003
Mailing address
PO BOX 287, GARIBALDI, OR 97118-0287
(503) 322-3456
(503) 322-0003
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
RP0000226
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2077879
PK
—
05
—
282228
—
OR
Enumeration date
01/30/2007
Last updated
05/20/2014
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