Individual
GARY DAVID HAVERLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.S. PHARMACY
Contact information
Practice address
15150 CEDAR AVE, T-0643, APPLE VALLEY, MN 55124-7056
(952) 891-5515
(952) 891-5516
Mailing address
15150 CEDAR AVE, T-0643, APPLE VALLEY, MN 55124-7056
(952) 891-5515
(952) 891-5516
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
115520
MN
Other
Enumeration date
06/14/2011
Last updated
06/14/2011
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