Provider Demographics
NPI:1881688786
Name:HAIRE DRUG COMPANY
Entity Type:Organization
Organization Name:HAIRE DRUG COMPANY
Other - Org Name:HAIRE DRUG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-843-4211
Mailing Address - Street 1:PO BOX 1738
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-1738
Mailing Address - Country:US
Mailing Address - Phone:662-843-4211
Mailing Address - Fax:662-843-0919
Practice Address - Street 1:805 1ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2309
Practice Address - Country:US
Practice Address - Phone:662-843-4211
Practice Address - Fax:662-843-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0330219Medicaid
MS2508349OtherNABP
MS1217670001Medicare ID - Type Unspecified