Provider Demographics
NPI:1073974655
Name:HAFLETT, LYLE A (R PH)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:A
Last Name:HAFLETT
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1228
Mailing Address - Country:US
Mailing Address - Phone:570-297-2848
Mailing Address - Fax:570-297-2841
Practice Address - Street 1:14 ELMIRA ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1228
Practice Address - Country:US
Practice Address - Phone:570-297-2848
Practice Address - Fax:570-297-2841
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP026498L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist