Provider Demographics
NPI:1134492713
Name:GODSEY, SANDRA DENISE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DENISE
Last Name:GODSEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 BROWN AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-4350
Mailing Address - Country:US
Mailing Address - Phone:423-650-1062
Mailing Address - Fax:
Practice Address - Street 1:635 PAUL HUFF PKWY NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2970
Practice Address - Country:US
Practice Address - Phone:423-650-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN050106009669249183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician