Provider Demographics
NPI:1942411053
Name:HAFFNER, JEFFREY RAY (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RAY
Last Name:HAFFNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45786-6203
Mailing Address - Country:US
Mailing Address - Phone:740-749-3609
Mailing Address - Fax:
Practice Address - Street 1:1506 ELIZABETH PIKE
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150
Practice Address - Country:US
Practice Address - Phone:304-489-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005438183500000X
OH03-3-19902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist