Provider Demographics
NPI:1467034348
Name:GODARD, KYNDALL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KYNDALL
Middle Name:
Last Name:GODARD
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 1:3003 WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-8234
Mailing Address - Country:US
Mailing Address - Phone:770-733-3479
Mailing Address - Fax:
Practice Address - Street 1:6111 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-1511
Practice Address - Country:US
Practice Address - Phone:757-637-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202219125OtherVIRGINIA BOARD OF PHARMACY