Provider Demographics
NPI:1396974168
Name:HAYNES, KAREN SUE (PHARMD)
Entity type:Individual
Prefix:
First Name:KAREN SUE
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14619 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1905
Mailing Address - Country:US
Mailing Address - Phone:206-420-8449
Mailing Address - Fax:
Practice Address - Street 1:14619 6TH AVENUE SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1905
Practice Address - Country:US
Practice Address - Phone:206-420-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00046647183500000X
NH3208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist