Provider Demographics
NPI:1932700853
Name:GODFREY, SHELDON MARC
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:MARC
Last Name:GODFREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 WHIMSEY LN
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2833
Mailing Address - Country:US
Mailing Address - Phone:240-888-8104
Mailing Address - Fax:
Practice Address - Street 1:4408 WHIMSEY LN
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2833
Practice Address - Country:US
Practice Address - Phone:240-888-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist