Provider Demographics
NPI:1619100781
Name:HAINES, HEIDI N (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:N
Last Name:HAINES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DOYLE ST
Mailing Address - Street 2:
Mailing Address - City:GERRARDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25420-4525
Mailing Address - Country:US
Mailing Address - Phone:304-229-5454
Mailing Address - Fax:
Practice Address - Street 1:7916 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-4066
Practice Address - Country:US
Practice Address - Phone:304-229-0935
Practice Address - Fax:304-229-5790
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist