Healthcare Provider Details

I. General information

NPI: 1104458173
Provider Name (Legal Business Name): GOVINDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 BOILING SPRINGS RD STE D
BOILING SPRINGS SC
29316-5361
US

IV. Provider business mailing address

2528 BOILING SPRINGS RD STE D
BOILING SPRINGS SC
29316-5361
US

V. Phone/Fax

Practice location:
  • Phone: 864-515-2600
  • Fax: 864-256-3499
Mailing address:
  • Phone: 864-515-2600
  • Fax: 864-256-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KUNTAL PATEL
Title or Position: PARTNER
Credential: RPH
Phone: 864-237-5501