Provider Demographics
NPI:1558746909
Name:NA, HAYEON (PHARMD)
Entity Type:Individual
Prefix:
First Name:HAYEON
Middle Name:
Last Name:NA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HA YEON
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:13505 20TH AVE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2446
Mailing Address - Country:US
Mailing Address - Phone:917-647-4572
Mailing Address - Fax:347-542-5120
Practice Address - Street 1:13505 20TH AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2446
Practice Address - Country:US
Practice Address - Phone:917-647-4572
Practice Address - Fax:347-542-5120
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist