Provider Demographics
NPI:1114698115
Name:LEFAIVRE, HALEY K (RPH)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:K
Last Name:LEFAIVRE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 E 135TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1365
Mailing Address - Country:US
Mailing Address - Phone:307-922-2100
Mailing Address - Fax:
Practice Address - Street 1:2400 E MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80243
Practice Address - Country:US
Practice Address - Phone:303-404-3754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00237183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy