Provider Demographics
NPI:1922266584
Name:HAYES DRUG LLC
Entity Type:Organization
Organization Name:HAYES DRUG LLC
Other - Org Name:HAYES DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GASTON
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:276-988-4414
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651
Mailing Address - Country:US
Mailing Address - Phone:276-988-4414
Mailing Address - Fax:276-988-5151
Practice Address - Street 1:689 FREEDOM AVE
Practice Address - Street 2:
Practice Address - City:NORTH TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24630-5168
Practice Address - Country:US
Practice Address - Phone:276-988-4414
Practice Address - Fax:276-988-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010042373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1922266584Medicaid
2106350OtherPK
VA1922266584Medicaid