Provider Demographics
NPI:1215372628
Name:HAINES, HAILEY ELLIOTT (PHARMD)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:ELLIOTT
Last Name:HAINES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 PLANTATION RD NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-5713
Mailing Address - Country:US
Mailing Address - Phone:800-227-6337
Mailing Address - Fax:188-843-6911
Practice Address - Street 1:1326 PLANTATION RD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5713
Practice Address - Country:US
Practice Address - Phone:800-227-6337
Practice Address - Fax:188-843-6911
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist