Healthcare Provider Details

I. General information

NPI: 1447329594
Provider Name (Legal Business Name): HENRY THOMAS HAYDEN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WARD AVE
CARUTHERSVILLE MO
63830-2204
US

IV. Provider business mailing address

1200 WARD AVE
CARUTHERSVILLE MO
63830-2204
US

V. Phone/Fax

Practice location:
  • Phone: 800-626-6934
  • Fax: 573-333-2843
Mailing address:
  • Phone: 800-626-6934
  • Fax: 573-333-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027636
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: