Provider Demographics
NPI:1215036025
Name:HAYNES, SHIRLI ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:SHIRLI
Middle Name:ANNE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHIRLI
Other - Middle Name:ANNE
Other - Last Name:BRINKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:20 CINNAMON CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1758
Mailing Address - Country:US
Mailing Address - Phone:317-858-7770
Mailing Address - Fax:
Practice Address - Street 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:M105
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-217-3355
Practice Address - Fax:317-217-3363
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016900A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist