Provider Demographics
NPI:1003229972
Name:HALEY, DUROTOLU
Entity Type:Individual
Prefix:
First Name:DUROTOLU
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14111 TIMBER WAY
Mailing Address - Street 2:
Mailing Address - City:TIMBERVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22853-9582
Mailing Address - Country:US
Mailing Address - Phone:540-896-6407
Mailing Address - Fax:
Practice Address - Street 1:14111 TIMBER WAY
Practice Address - Street 2:
Practice Address - City:TIMBERVILLE
Practice Address - State:VA
Practice Address - Zip Code:22853-9582
Practice Address - Country:US
Practice Address - Phone:540-896-6407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist