Provider Demographics
NPI:1104458173
Name:GOVINDA LLC
Entity type:Organization
Organization Name:GOVINDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KUNTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-237-5501
Mailing Address - Street 1:2528 BOILING SPRINGS RD STE D
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5361
Mailing Address - Country:US
Mailing Address - Phone:864-515-2600
Mailing Address - Fax:864-256-3499
Practice Address - Street 1:2528 BOILING SPRINGS RD STE D
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5361
Practice Address - Country:US
Practice Address - Phone:864-515-2600
Practice Address - Fax:864-256-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7Z1071Medicaid