Provider Demographics
NPI:1306216122
Name:HAYNES, MIRANDA J (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:J
Last Name:HAYNES
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N APPLE BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-8679
Mailing Address - Country:US
Mailing Address - Phone:509-682-4634
Mailing Address - Fax:
Practice Address - Street 1:108 N APPLE BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-8679
Practice Address - Country:US
Practice Address - Phone:509-682-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3580183500000X
WAPH60542865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist