Provider Demographics
NPI:1639160732
Name:HAYDEN FAMILY PHARMACY P C
Entity Type:Organization
Organization Name:HAYDEN FAMILY PHARMACY P C
Other - Org Name:HAYDEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:205-590-1515
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35079-0665
Mailing Address - Country:US
Mailing Address - Phone:205-590-1515
Mailing Address - Fax:205-590-2525
Practice Address - Street 1:4086 STATE HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:AL
Practice Address - Zip Code:35079-6551
Practice Address - Country:US
Practice Address - Phone:205-590-1515
Practice Address - Fax:205-590-2525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAYDEN FAMILY PHARMACY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1125983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003625Medicaid
AL01D2107085OtherCLIA
AL0132819OtherNABP
AL0132819OtherNABP