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A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Long Term Care Pharmacy |
3336L0003X | 58 | Medical Supply Company with Pharmacist | |
Managed Care Organization Pharmacy |
3336M0003X | 58 | Medical Supply Company with Pharmacist |
| NPI # | 1255591418 |
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| LBN Legal business name | HAVASU HEALTH CARE PHARM | ||||||||
| Authorized official | KELLY DAHLBERG - (OWNER) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 06/11/2008 | ||||||||
| Last updated | 06/11/2008 - About 18 years ago | ||||||||
| Identifiers |
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HAVASU HEALTH CARE PHARM
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HAVASU HEALTH CARE PHARM