Provider Demographics
NPI:1942415740
Name:HAYNES, RPH, GREGORY KYLE (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:KYLE
Last Name:HAYNES, RPH
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 1:500 MARKET ST STE 4
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2868
Mailing Address - Country:US
Mailing Address - Phone:740-284-1810
Mailing Address - Fax:
Practice Address - Street 1:500 MARKET ST STE 4
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2868
Practice Address - Country:US
Practice Address - Phone:740-284-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRPH 03219536OtherOHIO STATE BOARD OF PHARMACY