Provider Demographics
NPI:1720829567
Name:DEHAVEN, MEGAN BROOKE (PHARMD, BCPS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:BROOKE
Last Name:DEHAVEN
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 POPE DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2229
Mailing Address - Country:US
Mailing Address - Phone:864-934-7906
Mailing Address - Fax:
Practice Address - Street 1:131 BROADBENT WAY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-1521
Practice Address - Country:US
Practice Address - Phone:864-222-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC430321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist