Provider Demographics
NPI:1710702923
Name:GOVER, JOHN NIKLAS IV (CPHT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NIKLAS
Last Name:GOVER
Suffix:IV
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10718 POTRANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3312
Mailing Address - Country:US
Mailing Address - Phone:210-681-2250
Mailing Address - Fax:210-681-5736
Practice Address - Street 1:10718 POTRANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3312
Practice Address - Country:US
Practice Address - Phone:210-681-2250
Practice Address - Fax:210-681-5736
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX257854183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician