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General NPI Number Information
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NPI Number | 1134492713
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Entity Type | Individual
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Provider Name | SANDRA DENISE GODSEY CPHT
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Gender | Female
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 635 PAUL HUFF PKWY NW
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City | CLEVELAND
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State | TN
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Zip | 37312-2970
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Country | US
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Telephone | 423-650-1062
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Fax |
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Provider Business Mailing Address
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Address Line | 1463 BROWN AVE NW
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City | CLEVELAND
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State | TN
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Zip | 37311-4350
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Country | US
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Telephone | 423-650-1062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 050106009669249
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License Number State | TN
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