Provider Demographics
NPI:1467920264
Name:GODSEY, SARAH HILT
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:HILT
Last Name:GODSEY
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 1:808 DESOTO ST APT 14
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3756
Mailing Address - Country:US
Mailing Address - Phone:503-309-0734
Mailing Address - Fax:
Practice Address - Street 1:808 DESOTO ST APT 14
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3756
Practice Address - Country:US
Practice Address - Phone:503-309-0734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist