Provider Demographics
NPI:1679299200
Name:GODOY, CHRISTINE JEAN
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JEAN
Last Name:GODOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 OKEECHOBEE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4622
Mailing Address - Country:US
Mailing Address - Phone:561-615-6818
Mailing Address - Fax:561-615-0624
Practice Address - Street 1:4560 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4622
Practice Address - Country:US
Practice Address - Phone:561-615-6818
Practice Address - Fax:561-615-0624
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist