Healthcare Provider Details

I. General information

NPI: 1558753145
Provider Name (Legal Business Name): ROBERT HAYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 01/12/2020
Certification Date: 01/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 HARRISON AVE
CINCINNATI OH
45248-1606
US

IV. Provider business mailing address

210 EDGEFIELD DR
CLEVES OH
45002-1426
US

V. Phone/Fax

Practice location:
  • Phone: 513-574-5044
  • Fax: 513-574-3457
Mailing address:
  • Phone: 513-226-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03230370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: