Provider Demographics
NPI:1003243114
Name:HAINES, ELVIEANNA LYNNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:ELVIEANNA
Middle Name:LYNNE
Last Name:HAINES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E EPLER AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1902
Mailing Address - Country:US
Mailing Address - Phone:317-788-6671
Mailing Address - Fax:
Practice Address - Street 1:455 E EPLER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1902
Practice Address - Country:US
Practice Address - Phone:317-788-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026396A183500000X
OK15108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist