Provider Demographics
NPI:1629113105
Name:HALEY DRUG
Entity Type:Organization
Organization Name:HALEY DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-342-6691
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:OK
Mailing Address - Zip Code:73568-0130
Mailing Address - Country:US
Mailing Address - Phone:580-342-6691
Mailing Address - Fax:580-342-6452
Practice Address - Street 1:102 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:OK
Practice Address - Zip Code:73568-0130
Practice Address - Country:US
Practice Address - Phone:580-342-6691
Practice Address - Fax:580-342-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK651293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3707950OtherNABP