Provider Demographics
NPI:1578886768
Name:GOVEL, TIMOTHY (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:GOVEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HAWLEY RD
Mailing Address - Street 2:
Mailing Address - City:NIVERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12130-2104
Mailing Address - Country:US
Mailing Address - Phone:518-784-9385
Mailing Address - Fax:
Practice Address - Street 1:158 HAWLEY RD
Practice Address - Street 2:
Practice Address - City:NIVERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12130-2104
Practice Address - Country:US
Practice Address - Phone:518-784-9385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist