Organization
HAVANA PHARMACY AND MEDICAL SUPPLY LLC
Active
Other names
Havana Pharmacy and Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE SACKEY RPH (PHARMACIST/OWNER)
(303) 668-0032
Entity
Organization
Contact information
Practice address
1555 S HAVANA ST UNIT HJ, AURORA, CO 80012-5004
(303) 750-3600
(303) 750-3607
Mailing address
1555 S HAVANA ST UNIT HJ, AURORA, CO 80012-5004
(303) 750-3600
(303) 750-3607
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
836
CO
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0622363
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/13/2011
Last updated
03/20/2014
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