Provider Demographics
NPI:1477158400
Name:CATALLA, GODWIN LOREZCA (RPH)
Entity type:Individual
Prefix:MR
First Name:GODWIN
Middle Name:LOREZCA
Last Name:CATALLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24738 PARA SIEMPRE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2982
Mailing Address - Country:US
Mailing Address - Phone:210-725-2508
Mailing Address - Fax:
Practice Address - Street 1:17307 BULVERDE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-2008
Practice Address - Country:US
Practice Address - Phone:210-404-9054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist