Provider Demographics
NPI:1336316512
Name:HAYESVILLE PHARMACY LLC
Entity Type:Organization
Organization Name:HAYESVILLE PHARMACY LLC
Other - Org Name:HAYESVILLE PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-389-6900
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-1559
Mailing Address - Country:US
Mailing Address - Phone:828-389-6900
Mailing Address - Fax:828-389-6966
Practice Address - Street 1:808 NC HWY 69
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904
Practice Address - Country:US
Practice Address - Phone:828-389-6900
Practice Address - Fax:828-389-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705406Medicaid
NC0225179Medicaid
2067286OtherPK
NC7705406Medicaid