Provider Demographics
NPI:1023391943
Name:GOVANI, MARILU (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARILU
Middle Name:
Last Name:GOVANI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1937
Mailing Address - Country:US
Mailing Address - Phone:617-894-7607
Mailing Address - Fax:
Practice Address - Street 1:4910 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1937
Practice Address - Country:US
Practice Address - Phone:617-894-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist