Healthcare Provider Details

I. General information

NPI: 1164419404
Provider Name (Legal Business Name): GARY LEE HAAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17316 SHEPHERDSTOWN PIKE SHARPSBURG PHARMACY INC
SHARPSBURG MD
21782-1626
US

IV. Provider business mailing address

5709 RED HILL RD
KEEDYSVILLE MD
21756-1461
US

V. Phone/Fax

Practice location:
  • Phone: 301-432-7223
  • Fax: 301-432-4423
Mailing address:
  • Phone: 301-432-6814
  • Fax: 301-432-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07531
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: