Healthcare Provider Details

I. General information

NPI: 1457441099
Provider Name (Legal Business Name): HAYEN APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 E POYNTZ AVE
MANHATTAN KS
66502-5045
US

IV. Provider business mailing address

461 E POYNTZ AVE
MANHATTAN KS
66502-5045
US

V. Phone/Fax

Practice location:
  • Phone: 785-770-7979
  • Fax: 785-539-0417
Mailing address:
  • Phone: 785-770-7979
  • Fax: 785-539-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number110014
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. PAUL C HAYEN
Title or Position: PHARMOCIST
Credential: RPH
Phone: 785-770-7979