Provider Demographics
NPI:1225349996
Name:GODWIN, DONALD RAY (BS)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:GODWIN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 IVY BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1996
Mailing Address - Country:US
Mailing Address - Phone:205-533-0861
Mailing Address - Fax:
Practice Address - Street 1:2101 PELHAM PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1116
Practice Address - Country:US
Practice Address - Phone:205-985-4895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist