Provider Demographics
NPI:1033786546
Name:HAINES, LEVINUS WILLIAM (CPHT-ADV)
Entity Type:Individual
Prefix:PROF
First Name:LEVINUS
Middle Name:WILLIAM
Last Name:HAINES
Suffix:
Gender:M
Credentials:CPHT-ADV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-3934
Mailing Address - Country:US
Mailing Address - Phone:812-207-5814
Mailing Address - Fax:
Practice Address - Street 1:2319 ALTA AVE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-3934
Practice Address - Country:US
Practice Address - Phone:812-207-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67021614A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician