Provider Demographics
NPI:1770869760
Name:GODEK, JOSEPH GERALD
Entity type:Individual
Prefix:MISS
First Name:JOSEPH
Middle Name:GERALD
Last Name:GODEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 GRANGER BLVD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2855
Mailing Address - Country:US
Mailing Address - Phone:508-229-0540
Mailing Address - Fax:508-229-8176
Practice Address - Street 1:99 GRANGER BLVD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2855
Practice Address - Country:US
Practice Address - Phone:508-229-0540
Practice Address - Fax:508-229-8176
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH15314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist