Active NPI
Kwame Kenyatta Haven, PHARM.D
- Pharmacist
- Gonzales, LA
National Provider Identifier
1558644369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18547
- Practice address
- 1624 N Burnside Ave
Gonzales, LA 70737-2139 - Phone
- (225) 644-7528
- Fax
- (225) 647-3949
- NPI assigned
- Sep 28, 2011
- Last updated
- Sep 28, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 18547 | LA | Primary |
Addresses
Primary practice location
1624 N Burnside Ave
Gonzales, LA 70737-2139
Mailing address
1624 North Burnside
Gonzales, LA 70737
Phone (225) 200-0164
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18547 | LA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Louisiana CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Louisiana CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317168000000",
"number": "1558644369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1624 NORTH BURNSIDE",
"city": "GONZALES",
"state": "LA",
"postal_code": "70737",
"telephone_number": "225-200-0164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1624 N BURNSIDE AVE",
"city": "GONZALES",
"state": "LA",
"postal_code": "707372139",
"telephone_number": "225-644-7528",
"fax_number": "225-647-3949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVEN",
"first_name": "KWAME",
"middle_name": "KENYATTA",
"name_prefix": "Dr.",
"credential": "PHARM.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-28",
"last_updated": "2011-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "18547",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gonzales, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.