Provider Demographics
NPI:1215095054
Name:HAVEMAN, LAWRENCE MARVIN (RPH)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:MARVIN
Last Name:HAVEMAN
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 1:8289 ROCKLEDGE WAY SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8476
Mailing Address - Country:US
Mailing Address - Phone:616-878-6088
Mailing Address - Fax:
Practice Address - Street 1:MALCOM RANDALL VA MEDICAL CENTER
Practice Address - Street 2:1601 SW ARCHER RD.
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist