Provider Demographics
NPI:1982641965
Name:ANDERSON, HAYWARD (RPH)
Entity Type:Individual
Prefix:
First Name:HAYWARD
Middle Name:
Last Name:ANDERSON
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:N5520 STATE HIGHWAY 180
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-9305
Mailing Address - Country:US
Mailing Address - Phone:715-732-0717
Mailing Address - Fax:715-732-0596
Practice Address - Street 1:1435 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-2415
Practice Address - Country:US
Practice Address - Phone:715-732-0717
Practice Address - Fax:715-732-0596
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist