Provider Demographics
NPI:1750876538
Name:HAYES, STEPHANIE (PHARM D)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
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 1:503 VINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:AR
Mailing Address - Zip Code:72562-9711
Mailing Address - Country:US
Mailing Address - Phone:870-799-3411
Mailing Address - Fax:870-793-8439
Practice Address - Street 1:503 VINE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:AR
Practice Address - Zip Code:72562
Practice Address - Country:US
Practice Address - Phone:870-799-3411
Practice Address - Fax:870-793-8439
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist