Provider Demographics
NPI:1669719605
Name:GOVAN, HENNA SONAL VASUDEV (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HENNA
Middle Name:SONAL VASUDEV
Last Name:GOVAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 WOODSTOCK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2276
Mailing Address - Country:US
Mailing Address - Phone:770-552-4576
Mailing Address - Fax:
Practice Address - Street 1:885 WOODSTOCK RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2276
Practice Address - Country:US
Practice Address - Phone:770-552-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist