Provider Demographics
NPI:1902153695
Name:GODWIN, SHILO NOELLE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SHILO
Middle Name:NOELLE
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 1:6040 MEDICI CT
Mailing Address - Street 2:APT. 206
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2206
Mailing Address - Country:US
Mailing Address - Phone:850-712-1776
Mailing Address - Fax:
Practice Address - Street 1:3901 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3621
Practice Address - Country:US
Practice Address - Phone:941-926-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist