Provider Demographics
NPI:1144806159
Name:HAYMON, BRADLEY JOE
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JOE
Last Name:HAYMON
Suffix:
Gender:M
Credentials:
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 428
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-0428
Mailing Address - Country:US
Mailing Address - Phone:256-638-4142
Mailing Address - Fax:256-638-4149
Practice Address - Street 1:128 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986
Practice Address - Country:US
Practice Address - Phone:256-638-4142
Practice Address - Fax:256-638-4149
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist