Provider Demographics
NPI:1114254364
Name:HAIRSTON, DEBORAH ADRENE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ADRENE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4409
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033-4409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HWY 163, BLDG #KA-2010
Practice Address - Street 2:U.S.P. HS INDIAN HEALTH CTR,
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033-0000
Practice Address - Country:US
Practice Address - Phone:928-697-4165
Practice Address - Fax:928-697-4168
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024103321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist