Individual
DR. KWAME KENYATTA HAVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D
Contact information
Practice address
1624 N BURNSIDE AVE, GONZALES, LA 70737-2139
(225) 644-7528
(225) 647-3949
Mailing address
1624 NORTH BURNSIDE, GONZALES, LA 70737
(225) 200-0164
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18547
LA
Other
Enumeration date
09/28/2011
Last updated
09/28/2011
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