Leroy M Godfrey

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

RP0000226 Issued in OR

Legal business name

LEROY M GODFREY

Doing business as

Godfreys Garibaldi Pharmacy

Practice address

510 Garibaldi Ave
Garibaldi, OR 97118-1513

Phone

(503) 322-3456

Fax

(503) 322-0003

NPI assigned

Jan 30, 2007

Last updated

May 20, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Leroy Godfrey, RPH

Title

Owner

Phone

(503) 322-3456

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• GODFREYS GARIBALDI PHARMACY Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400544000000",
    "number": "1174669733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 287",
            "city": "GARIBALDI",
            "state": "OR",
            "postal_code": "971180287",
            "telephone_number": "503-322-3456",
            "fax_number": "503-322-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 GARIBALDI AVE",
            "city": "GARIBALDI",
            "state": "OR",
            "postal_code": "971181513",
            "telephone_number": "503-322-3456",
            "fax_number": "503-322-0003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEROY M GODFREY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2014-05-20",
        "status": "A",
        "authorized_official_last_name": "GODFREY",
        "authorized_official_first_name": "LEROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-322-3456",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "RP0000226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "282228",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2077879",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GODFREYS GARIBALDI PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cassandra Dean, RN
• James P Dow
• Mary K McCarthy Holloway, MD

• Community/Retail Pharmacy in Garibaldi, OR
• Providers in Garibaldi, OR by specialty
• Community/Retail Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.