Provider Demographics
NPI:1982151866
Name:HAISLIP, SALLY (RPH)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:HAISLIP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4662 LUCERNE VALLEY RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4416
Mailing Address - Country:US
Mailing Address - Phone:770-978-9499
Mailing Address - Fax:
Practice Address - Street 1:1835 SAVOY DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1072
Practice Address - Country:US
Practice Address - Phone:770-496-9457
Practice Address - Fax:770-496-9497
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL116931835X0200X
GA202581835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology