Healthcare Provider Details

I. General information

NPI: 1134800923
Provider Name (Legal Business Name): GRACE HAVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N HIGH ST
COLUMBUS OH
43201-2409
US

IV. Provider business mailing address

969 W 1ST AVE
COLUMBUS OH
43212-3670
US

V. Phone/Fax

Practice location:
  • Phone: 614-340-6776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP457642
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03443365
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: