| Organization Name: | HAVANA PHARMACY AND MEDICAL SUPPLY LLC |
| NPI Number: | 1225455090 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARTHA MEJIA (FACILITY DIRECTOR) |
| Mailing Address: | 1555 S Havana St Ste Hj Aurora |
| State: | CO US |
| Postal Code: | 800125004 |
| Phone Number: | 3037503600 |
| Fax Number: | 3037503607 |
| NPI Enumeration Date: | 03/18/2014 |
| NPI Last Update Date: | 03/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 0000000836 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |