Provider Demographics
NPI:1518228089
Name:HAYES, DANNIE MARION (RPH)
Entity Type:Individual
Prefix:
First Name:DANNIE
Middle Name:MARION
Last Name:HAYES
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 1:7445 CLINTON RD
Mailing Address - Street 2:PO BOX 625
Mailing Address - City:STEDMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28391-8901
Mailing Address - Country:US
Mailing Address - Phone:910-323-4555
Mailing Address - Fax:910-483-0515
Practice Address - Street 1:7445 CLINTON RD
Practice Address - Street 2:
Practice Address - City:STEDMAN
Practice Address - State:NC
Practice Address - Zip Code:28391-8901
Practice Address - Country:US
Practice Address - Phone:910-323-4555
Practice Address - Fax:910-483-0515
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC006899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144542994OtherEASTOVER DRUG LLC NPI
2340883AOtherMEDICARE MASS IMMUNIZATION ROSTER BILLER
NC0265652Medicaid
1023084985OtherSTEDMAN DRUG CENTER NPI
NC7700252Medicaid
6444130001Medicare NSC
0421580001Medicare NSC