Provider Demographics
NPI:1457643470
Name:HAVERA, BRUCE RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:RICHARD
Last Name:HAVERA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BROOK LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1513
Mailing Address - Country:US
Mailing Address - Phone:570-474-9077
Mailing Address - Fax:
Practice Address - Street 1:77 BROOK LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1513
Practice Address - Country:US
Practice Address - Phone:570-474-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030068L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist