Healthcare Provider Details

I. General information

NPI: 1124211693
Provider Name (Legal Business Name): MICHAEL S HAYES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2007
Last Update Date: 08/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27-41 GANSEVOORT RD
SOUTH GLENS FALLS NY
12803-5256
US

IV. Provider business mailing address

PO BOX 1000 MS 3000
PORTLAND ME
04104-5005
US

V. Phone/Fax

Practice location:
  • Phone: 518-798-2847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: