Provider Demographics
NPI:1316238223
Name:HAVEL, CLARISSA F
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:F
Last Name:HAVEL
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 1:2319 SCOTT LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-4410
Mailing Address - Country:US
Mailing Address - Phone:630-820-1471
Mailing Address - Fax:
Practice Address - Street 1:2319 SCOTT LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-4410
Practice Address - Country:US
Practice Address - Phone:630-820-1471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI269711835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy