Provider Demographics
NPI:1073954632
Name:HAVERINEN, JUSTINE A (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:A
Last Name:HAVERINEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-1416
Mailing Address - Country:US
Mailing Address - Phone:401-598-6090
Mailing Address - Fax:
Practice Address - Street 1:1279 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2652
Practice Address - Country:US
Practice Address - Phone:401-463-8039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist