Provider Demographics
NPI:1265981245
Name:GODINA, ALVIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:GODINA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WOODLAND CT
Mailing Address - Street 2:APT C3
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 WOODLAND CT
Practice Address - Street 2:APT C3
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2157
Practice Address - Country:US
Practice Address - Phone:708-228-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist