Provider Demographics
NPI:1780904243
Name:GODFREY, DANIEL MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:GODFREY
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 1:5983 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1868
Mailing Address - Country:US
Mailing Address - Phone:248-673-2059
Mailing Address - Fax:248-673-4736
Practice Address - Street 1:5983 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1868
Practice Address - Country:US
Practice Address - Phone:248-673-2059
Practice Address - Fax:248-673-4736
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist