MEDICARE: JESSICA GODIN

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	0015622	CT

General Provider Information

NPI Number	:	1447992946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GODIN

Provider Business Mailing Address
First Line	:	405 HARTFORD RD
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06053-1507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 HARTFORD RD
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06053-1507
Country	:	US
Telephone Number	:	860-893-7011
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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Directions to “ JESSICA GODIN ” Practice Location

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