NPI | 1073078713 |
---|---|
Former Name | BROOKE DEE HAVLAT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 183500000X Pharmacist (Licence: NE 16117) |
Additional Taxonomies | 183500000X Pharmacist (Licence: IA 23461) |
Enumeration Date | 2019-02-06 |
Last Update Date | 2020-05-06 |