Healthcare Provider Details

I. General information

NPI: 1629908793
Provider Name (Legal Business Name): MARK LESLIE HAYES R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 BUENA VISTA AVE
ALAMEDA CA
94501-1358
US

IV. Provider business mailing address

2061 BUENA VISTA AVE
ALAMEDA CA
94501-1358
US

V. Phone/Fax

Practice location:
  • Phone: 202-302-2365
  • Fax:
Mailing address:
  • Phone: 202-302-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202009557
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: