Organization
HAVASU HEALTH CARE PHARM
Active
Other names
HAVASU HEALTH CARE PHARM
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY DAHLBERG (OWNER)
(928) 855-9888
Entity
Organization
Contact information
Practice address
3560 CHALLENGER DR, STE 106, LAKE HAVASU CITY, AZ 86406-9152
(928) 855-9888
(928) 855-9888
Mailing address
3560 CHALLENGER DR, STE 106, LAKE HAVASU CITY, AZ 86406-9152
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
Y0004984
AZ
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0355366
OTHER ID NUMBER
—
Enumeration date
06/11/2008
Last updated
06/11/2008
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