Healthcare Provider Details

I. General information

NPI: 1356366207
Provider Name (Legal Business Name): HAYNES DAVIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W SCHARBAUER DR
MIDLAND TX
79705-8925
US

IV. Provider business mailing address

PO BOX 51388
MIDLAND TX
79710-1388
US

V. Phone/Fax

Practice location:
  • Phone: 432-682-2519
  • Fax: 432-682-5857
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number22694
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN DAVIS
Title or Position: PIC
Credential: RPH
Phone: 432-682-2519