Healthcare Provider Details

I. General information

NPI: 1942415740
Provider Name (Legal Business Name): GREGORY KYLE HAYNES, RPH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARKET ST STE 4
STEUBENVILLE OH
43952-2868
US

IV. Provider business mailing address

500 MARKET ST STE 4
STEUBENVILLE OH
43952-2868
US

V. Phone/Fax

Practice location:
  • Phone: 740-284-1810
  • Fax:
Mailing address:
  • Phone: 740-284-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0005339
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: