# LEROY M GODFREY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GODFREYS GARIBALDI PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174669733
- **Authorized official:** LEROY GODFREY RPH (OWNER)
- **Authorized official phone:** (503) 322-3456

## Contact information

- **Practice address:** 510 GARIBALDI AVE, GARIBALDI, OR 97118-1513
- **Practice address phone:** (503) 322-3456
- **Practice address fax:** (503) 322-0003
- **Mailing address:** PO BOX 287, GARIBALDI, OR 97118-0287
- **Mailing address phone:** (503) 322-3456
- **Mailing address fax:** (503) 322-0003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | RP0000226 | OR | Yes |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 05/20/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2077879 | PK | — |
| 05 | — | 282228 | — | OR |