Provider Demographics
NPI:1740273598
Name:GODLESKI, GREGORY PETER (RPH)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:PETER
Last Name:GODLESKI
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 1:7502 E LESTER CIR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4514
Mailing Address - Country:US
Mailing Address - Phone:520-886-7084
Mailing Address - Fax:
Practice Address - Street 1:839 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2819
Practice Address - Country:US
Practice Address - Phone:520-205-4996
Practice Address - Fax:520-670-3842
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist