Provider Demographics
NPI:1356334585
Name:HARE GOVIND LLC
Entity type:Organization
Organization Name:HARE GOVIND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-321-7670
Mailing Address - Street 1:1091 GENERAL KNOX RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1359
Mailing Address - Country:US
Mailing Address - Phone:215-321-7670
Mailing Address - Fax:215-321-7640
Practice Address - Street 1:1091 GENERAL KNOX RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1359
Practice Address - Country:US
Practice Address - Phone:215-321-7670
Practice Address - Fax:215-321-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415365L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103964059Medicaid
PA5015560001Medicare NSC