MEDICARE: DR. MARILU GOVANI PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	19011	MD

General Provider Information

NPI Number	:	1023391943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILU GOVANI PHARM D

Provider Business Mailing Address
First Line	:	4910 LINCOLN AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-1937
Country	:	US
Telephone Number	:	617-894-7607
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 LINCOLN AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-1937
Country	:	US
Telephone Number	:	617-894-7607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	09/27/2011

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