Provider Demographics
NPI:1376837658
Name:VAIDYANATHAN, GOVINDAN (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:GOVINDAN
Middle Name:
Last Name:VAIDYANATHAN
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 DEBRA CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3699
Mailing Address - Country:US
Mailing Address - Phone:301-340-6956
Mailing Address - Fax:301-340-6956
Practice Address - Street 1:5624 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:RITE AID PHARMACY STORE 374
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1401
Practice Address - Country:US
Practice Address - Phone:410-719-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18471183500000X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care