Provider Demographics
NPI:1750978516
Name:HABERLAND, DAVID H (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:HABERLAND
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 1:3363 KNOX SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44634-9713
Mailing Address - Country:US
Mailing Address - Phone:330-614-2533
Mailing Address - Fax:
Practice Address - Street 1:600 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9643
Practice Address - Country:US
Practice Address - Phone:330-877-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03114966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist