Healthcare Provider Details

I. General information

NPI: 1508460940
Provider Name (Legal Business Name): ANNA NOELLE MCGOVERN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 MARKET ST
CAMP HILL PA
17011-4422
US

IV. Provider business mailing address

3201 MARKET ST
CAMP HILL PA
17011-4422
US

V. Phone/Fax

Practice location:
  • Phone: 717-303-3020
  • Fax:
Mailing address:
  • Phone: 717-303-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454253
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: