Provider Demographics
NPI:1356851190
Name:HAUGH, MARK EAMER (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EAMER
Last Name:HAUGH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DRAW BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-2121
Mailing Address - Country:US
Mailing Address - Phone:980-233-1940
Mailing Address - Fax:
Practice Address - Street 1:60 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9405
Practice Address - Country:US
Practice Address - Phone:828-684-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35969183500000X
NC17133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS35969OtherFLORIDA BOARD OF PHARMACY - PHARMACIST LICENSE
NC17133OtherNC BOARD OF PHARMACY PHARMACIST LICENSE