Provider Demographics
NPI:1811360100
Name:HAYWOOD RX LLC
Entity type:Organization
Organization Name:HAYWOOD RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWER/RPH
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-518-3428
Mailing Address - Street 1:8900 RUFFIAN LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3424
Mailing Address - Country:US
Mailing Address - Phone:812-518-3428
Mailing Address - Fax:812-518-3430
Practice Address - Street 1:8900 RUFFIAN LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3424
Practice Address - Country:US
Practice Address - Phone:812-518-3428
Practice Address - Fax:812-518-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2156160OtherPK
IN60006504AOtherSTATE LICENSE NUMBER