MEDICARE: DR. SANDRA GODSWILL PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	49570	TX

General Provider Information

NPI Number	:	1205436805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA GODSWILL PHARMD

Provider Business Mailing Address
First Line	:	7529 GRASS VALLEY TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2876
Country	:	US
Telephone Number	:	713-885-8966
Fax Number	:

Provider Business Practice Location Address
First Line	:	8840 BENBROOK BLVD
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-2173
Country	:	US
Telephone Number	:	682-233-6827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2020
Last Update Date	:	11/01/2020

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