Provider Demographics
NPI:1871180489
Name:GODWIN, JESSICA FAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FAY
Last Name:GODWIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4103
Mailing Address - Country:US
Mailing Address - Phone:580-233-2152
Mailing Address - Fax:580-233-2168
Practice Address - Street 1:127 E RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4103
Practice Address - Country:US
Practice Address - Phone:580-233-2152
Practice Address - Fax:580-233-2168
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist