Provider Demographics
NPI:1649455643
Name:HAVENS, JOSHUA PHILIP (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:PHILIP
Last Name:HAVENS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S. 52ND
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106
Mailing Address - Country:US
Mailing Address - Phone:402-559-2674
Mailing Address - Fax:402-553-5963
Practice Address - Street 1:804 S. 52ND
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106
Practice Address - Country:US
Practice Address - Phone:402-559-2674
Practice Address - Fax:402-553-5963
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12703261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service