1841332798 NPI number — HAMILTON YORK HALEY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841332798 NPI number — HAMILTON YORK HALEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMILTON YORK HALEY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1841332798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 MAIN ST
Provider Second Line Business Mailing Address:
P.O. BOX 66
Provider Business Mailing Address City Name:
FRIENDSHIP
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38034-1966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-677-2155
Provider Business Mailing Address Fax Number:
731-677-2252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
632 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIENDSHIP
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38034-1966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-677-2155
Provider Business Practice Location Address Fax Number:
731-677-2252
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALEY
Authorized Official First Name:
HAMILTON
Authorized Official Middle Name:
YORK
Authorized Official Title or Position:
PHARMACIST OWNER
Authorized Official Telephone Number:
731-677-2155

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  3078 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3078 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4406446 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com