Provider Demographics
NPI:1699858969
Name:HAVERN, SUZANNE MARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:HAVERN
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 1:1750 WENTWORTH DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3089
Mailing Address - Country:US
Mailing Address - Phone:734-495-3526
Mailing Address - Fax:
Practice Address - Street 1:129 S PUTNAM ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-1335
Practice Address - Country:US
Practice Address - Phone:517-655-2420
Practice Address - Fax:517-655-6732
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist