Provider Demographics
NPI:1023568292
Name:TUFTS GODBOUT, AJA LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AJA
Middle Name:LEE
Last Name:TUFTS GODBOUT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10636 SCRIPPS SUMMIT CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3965
Mailing Address - Country:US
Mailing Address - Phone:858-790-7188
Mailing Address - Fax:
Practice Address - Street 1:10636 SCRIPPS SUMMIT CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3965
Practice Address - Country:US
Practice Address - Phone:858-790-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5216183500000X
CA56852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist