| NPI | 1699205971 |
|---|---|
| Doing Business As | BLUE HAVEN PHARMACY |
| Entity Type | Organization |
| Authorized Contact | ROBERTO ROLANDO OLIVARES Managing Member/President 512-693-4222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 31459) |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2017-06-29 |