Havasu Health Care Pharm

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

Y0004984 Issued in AZ

Legal business name

HAVASU HEALTH CARE PHARM

Doing business as

HAVASU HEALTH CARE PHARM

Practice address

3560 Challenger Dr
Ste 106
Lake Havasu City, AZ 86406-9152

Phone

(928) 855-9888

Fax

(928) 855-9888

NPI assigned

Jun 11, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Dahlberg

Title

Owner

Phone

(928) 855-9888

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• HAVASU HEALTH CARE PHARM Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1255591418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3560 CHALLENGER DR",
            "address_2": "STE 106",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864069152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3560 CHALLENGER DR",
            "address_2": "STE 106",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864069152",
            "telephone_number": "928-855-9888",
            "fax_number": "928-855-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVASU HEALTH CARE PHARM",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "DAHLBERG",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-855-9888"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "AZ",
            "license": "Y0004984",
            "primary": true
        },
        {
            "code": "3336M0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Managed Care Organization Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "0355366",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAVASU HEALTH CARE PHARM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Havasu Cardiac Surgery PLLC
• Havasu Dental Center PLLC
• Havasu Emergency Physicians, PC
• Havasu Foot & Ankle Center
• Havasu Foot & Ankle Center
• Havasu Lung and Sleep Disorders Center LLC
• Havasu Medical Care
• Havasu Medical Supply Inc.
• Havasu Neurological Center PLLC
• Havasu Nursing Center 2 Inc

• Long Term Care Pharmacy in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Long Term Care Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.