Provider Demographics
NPI:1215449301
Name:HAYNES, SIERRA
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 LAMBERT HILL RD
Mailing Address - Street 2:
Mailing Address - City:STRONG
Mailing Address - State:ME
Mailing Address - Zip Code:04983-3018
Mailing Address - Country:US
Mailing Address - Phone:207-320-8992
Mailing Address - Fax:
Practice Address - Street 1:15 JAY PLAZA LN
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:ME
Practice Address - Zip Code:04239-5095
Practice Address - Country:US
Practice Address - Phone:207-897-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR45424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist