Healthcare Provider Details

I. General information

NPI: 1811360100
Provider Name (Legal Business Name): HAYWOOD RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 RUFFIAN LN
NEWBURGH IN
47630-3424
US

IV. Provider business mailing address

8900 RUFFIAN LN
NEWBURGH IN
47630-3424
US

V. Phone/Fax

Practice location:
  • Phone: 812-518-3428
  • Fax: 812-518-3430
Mailing address:
  • Phone: 812-518-3428
  • Fax: 812-518-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK HAYWOOD
Title or Position: OWER/RPH
Credential:
Phone: 812-518-3428