MEDICARE: HAYES PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1003256116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYES PHARMACY

Provider Business Mailing Address
First Line	:	5420 PALOMA BLANCA DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76179-7500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5420 PALOMA BLANCA DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76179-7500
Country	:	US
Telephone Number	:	805-416-1648
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	SHANNON PORTER
Credential	:
Telephone Number	:	805-416-1648

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	07/03/2013

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Directions to “HAYES PHARMACY ” Practice Location

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