Provider Demographics
NPI:1801061767
Name:GODINES, DAVID J (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:GODINES
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 1:2701 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3907
Mailing Address - Country:US
Mailing Address - Phone:512-478-8086
Mailing Address - Fax:512-472-9089
Practice Address - Street 1:2701 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3907
Practice Address - Country:US
Practice Address - Phone:512-478-8086
Practice Address - Fax:512-472-9089
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX24464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist