Provider Demographics
NPI:1700108065
Name:HAYES, SHARA GAYLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHARA
Middle Name:GAYLE
Last Name:HAYES
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 1:5331 N SAMSON AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-1952
Mailing Address - Country:US
Mailing Address - Phone:208-323-9565
Mailing Address - Fax:
Practice Address - Street 1:286 N MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8239
Practice Address - Country:US
Practice Address - Phone:208-287-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011045183500000X
IDP6109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist