Provider Demographics
NPI:1972635969
Name:WELCOME, HAVNICCA
Entity Type:Individual
Prefix:MISS
First Name:HAVNICCA
Middle Name:
Last Name:WELCOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11092 TURNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2328
Mailing Address - Country:US
Mailing Address - Phone:904-646-1602
Mailing Address - Fax:
Practice Address - Street 1:10915 BAYMEADOWS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9130
Practice Address - Country:US
Practice Address - Phone:904-421-0633
Practice Address - Fax:904-421-6190
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist