1952308629 NPI number — GEORGE R HAYNES PHARMD

Table of content: GEORGE R HAYNES PHARMD (NPI 1952308629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952308629 NPI number — GEORGE R HAYNES PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYNES
Provider First Name:
GEORGE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952308629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4617 SIR GALAHAD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKHAVEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19015-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-447-8875
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N CLAYTON ST
Provider Second Line Business Practice Location Address:
PHARMACY
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19805-3165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-421-4295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP044807L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RP044807L . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A1-0003916 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".