Provider Demographics
NPI:1124102983
Name:GODHANI INC
Entity type:Organization
Organization Name:GODHANI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BHANU
Authorized Official - Middle Name:M
Authorized Official - Last Name:GODHANI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-279-5510
Mailing Address - Street 1:87 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505
Mailing Address - Country:US
Mailing Address - Phone:973-279-5510
Mailing Address - Fax:973-279-1234
Practice Address - Street 1:87 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505
Practice Address - Country:US
Practice Address - Phone:973-279-5510
Practice Address - Fax:973-279-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00366800333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4363906Medicaid
NJ0131580001Medicare NSC