Healthcare Provider Details

I. General information

NPI: 1144958323
Provider Name (Legal Business Name): MARCUS HOLT HAYNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W WILLIAM CANNON DR STE 400
AUSTIN TX
78745-5879
US

IV. Provider business mailing address

500 W WILLIAM CANNON DR STE 400
AUSTIN TX
78745-5879
US

V. Phone/Fax

Practice location:
  • Phone: 866-278-8432
  • Fax:
Mailing address:
  • Phone: 866-278-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0024529
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75912
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: