Provider Demographics
NPI:1407264260
Name:HAYNES, KATIE BRUSH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:BRUSH
Last Name:HAYNES
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 1:1404 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-2320
Mailing Address - Country:US
Mailing Address - Phone:336-887-4927
Mailing Address - Fax:
Practice Address - Street 1:1404 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2320
Practice Address - Country:US
Practice Address - Phone:336-887-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist