Provider Demographics
NPI:1598322943
Name:HAINES, RONALD GLENN SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:GLENN
Last Name:HAINES
Suffix:SR
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 1:13566 RUDI LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-7964
Mailing Address - Country:US
Mailing Address - Phone:727-858-8779
Mailing Address - Fax:
Practice Address - Street 1:742 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3710
Practice Address - Country:US
Practice Address - Phone:727-934-3400
Practice Address - Fax:727-934-3440
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU3518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist