Provider Demographics
NPI:1043388911
Name:HAYES, CARL R (RPH)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:R
Last Name:HAYES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:FRITZ
Other - Middle Name:
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:4052 BALD CYPRESS WAY
Mailing Address - Street 2:BIN C-16
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32399
Mailing Address - Country:US
Mailing Address - Phone:850-245-4797
Mailing Address - Fax:
Practice Address - Street 1:4052 BALD CYPRESS WAY
Practice Address - Street 2:BIN C-16
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32399
Practice Address - Country:US
Practice Address - Phone:850-245-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist