Healthcare Provider Details

I. General information

NPI: 1639084015
Provider Name (Legal Business Name): QUINTIN HAYES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W UNIVERSITY AVE STE 2345
URBANA IL
61801-1645
US

IV. Provider business mailing address

2410 FIELDS SOUTH DR APT 208
CHAMPAIGN IL
61822-3689
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number051.299581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: