MEDICARE: LAURA HAYNES

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	183500000X	Pharmacist	5671	SD

General Provider Information

NPI Number	:	1265815195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HAYNES

Provider Business Mailing Address
First Line	:	2700 W 12TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-3701
Country	:	US
Telephone Number	:	605-367-2210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 W 12TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-3701
Country	:	US
Telephone Number	:	605-367-2210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	07/09/2015

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Directions to “ LAURA HAYNES ” Practice Location

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