Provider Demographics
NPI:1841332798
Name:HAMILTON YORK HALEY
Entity type:Organization
Organization Name:HAMILTON YORK HALEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMILTON
Authorized Official - Middle Name:YORK
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:D PH
Authorized Official - Phone:731-677-2155
Mailing Address - Street 1:632 MAIN ST
Mailing Address - Street 2:P.O. BOX 66
Mailing Address - City:FRIENDSHIP
Mailing Address - State:TN
Mailing Address - Zip Code:38034-1966
Mailing Address - Country:US
Mailing Address - Phone:731-677-2155
Mailing Address - Fax:731-677-2252
Practice Address - Street 1:632 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:TN
Practice Address - Zip Code:38034-1966
Practice Address - Country:US
Practice Address - Phone:731-677-2155
Practice Address - Fax:731-677-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3078OtherPHARMACY LICENSE
TN4406446Medicaid
TN4406446Medicaid