Individual
MR. GEORGE JOSEPH HAVENS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
13546 COMPTON RIDGE DR, TRINIDAD, CO 81082-2859
(719) 310-1444
Mailing address
602 BALSAMROOT LN, VICTOR, MT 59875-9741
(719) 310-1444
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051.036002
IL
183500000X
Pharmacist
Primary
PHA-PHA-LIC-15025
MT
183500000X
Pharmacist
PHA.0019838
CO
Other
Enumeration date
10/03/2013
Last updated
07/30/2014
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