Provider Demographics
NPI:1083028609
Name:GOYAL, HEMENDRA (PHARM D)
Entity Type:Individual
Prefix:
First Name:HEMENDRA
Middle Name:
Last Name:GOYAL
Suffix:
Gender:M
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 1:894 FLAMMANG AVE
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3459
Mailing Address - Country:US
Mailing Address - Phone:760-554-1372
Mailing Address - Fax:
Practice Address - Street 1:610 S BRAWLEY AVE
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-3124
Practice Address - Country:US
Practice Address - Phone:760-344-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist