Healthcare Provider Details

I. General information

NPI: 1477693174
Provider Name (Legal Business Name): HAYDEN DRUG COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027636
License Number StateMO

VIII. Authorized Official

Name: HENRY HAYDEN
Title or Position: PHARMACIST OWNER
Credential: R.PH.
Phone: 800-626-6934