Provider Demographics
NPI:1891017356
Name:HAINES, DEBBIE LYNN (CPHT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:LYNN
Last Name:HAINES
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785-0189
Mailing Address - Country:US
Mailing Address - Phone:417-276-3128
Mailing Address - Fax:417-276-4914
Practice Address - Street 1:19 PUBLIC SQUARE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785
Practice Address - Country:US
Practice Address - Phone:417-276-3128
Practice Address - Fax:417-276-4914
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO221505030788515183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician