Healthcare Provider Details

I. General information

NPI: 1497855449
Provider Name (Legal Business Name): HAYMON DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MAIN ST E
RAINSVILLE AL
35986-4555
US

IV. Provider business mailing address

PO BOX 428
RAINSVILLE AL
35986-0428
US

V. Phone/Fax

Practice location:
  • Phone: 256-638-4142
  • Fax: 256-638-4149
Mailing address:
  • Phone: 256-638-4142
  • Fax: 256-638-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112494
License Number StateAL

VIII. Authorized Official

Name: BRADLEY HAYMON
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 256-638-4142