Provider Demographics
NPI:1578750030
Name:GODLEWSKI, MARY ANN D (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:D
Last Name:GODLEWSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 BROOKSBORO DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-4054
Mailing Address - Country:US
Mailing Address - Phone:814-825-9025
Mailing Address - Fax:
Practice Address - Street 1:53 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1303
Practice Address - Country:US
Practice Address - Phone:716-326-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist