Provider Demographics
NPI:1376146159
Name:DEHAVEN, NANCY L (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:DEHAVEN
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 1:140 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-9672
Mailing Address - Country:US
Mailing Address - Phone:570-966-3332
Mailing Address - Fax:570-966-4542
Practice Address - Street 1:140 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MIFFLINBURG
Practice Address - State:PA
Practice Address - Zip Code:17844-9672
Practice Address - Country:US
Practice Address - Phone:570-966-3332
Practice Address - Fax:570-966-4542
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038188L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist