Provider Demographics
NPI:1699261768
Name:GODWIN, CHEYENNE CIERRIA (PHARMD)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:CIERRIA
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 1:409 DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2120
Mailing Address - Country:US
Mailing Address - Phone:334-806-2557
Mailing Address - Fax:
Practice Address - Street 1:847 BOLL WEEVIL CIR STE 112
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2476
Practice Address - Country:US
Practice Address - Phone:334-348-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist