Provider Demographics
NPI:1265715494
Name:HAYSE, DRACO RODREGAS (PHARM D)
Entity type:Individual
Prefix:
First Name:DRACO
Middle Name:RODREGAS
Last Name:HAYSE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 HIGHWAY 309 S
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-8701
Mailing Address - Country:US
Mailing Address - Phone:662-564-2274
Mailing Address - Fax:
Practice Address - Street 1:6672 E SHELBY DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8439
Practice Address - Country:US
Practice Address - Phone:901-368-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11798183500000X
MSE-09474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist