Provider Demographics
NPI:1114773132
Name:HAVEN INTEGRATED PHARMACY OPERATIONS
Entity type:Organization
Organization Name:HAVEN INTEGRATED PHARMACY OPERATIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:OAXACA
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:801-604-8736
Mailing Address - Street 1:1890 S 3850 W STE 220
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-4939
Mailing Address - Country:US
Mailing Address - Phone:385-549-1121
Mailing Address - Fax:855-571-3472
Practice Address - Street 1:1890 S 3850 W STE 220
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-4939
Practice Address - Country:US
Practice Address - Phone:385-549-1121
Practice Address - Fax:855-571-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No251F00000XAgenciesHome Infusion
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy