Provider Demographics
NPI:1477335271
Name:HALEY, NIA MARY ORETHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIA
Middle Name:MARY ORETHA
Last Name:HALEY
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 1:7727 SAINT ALBANS AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2006
Mailing Address - Country:US
Mailing Address - Phone:504-481-7990
Mailing Address - Fax:
Practice Address - Street 1:7339 GRAVOIS AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-1040
Practice Address - Country:US
Practice Address - Phone:314-752-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023040537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist