=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063792018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAYDEN FAMILY PHARMACY P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2011
-----------------------------------------------------
Last Update Date | 09/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 88 WHITE OAK TRL
-----------------------------------------------------
City | WARRIOR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35180-4214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-590-1100
-----------------------------------------------------
Fax | 205-590-1120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 665
-----------------------------------------------------
City | HAYDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35079-0665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-590-1100
-----------------------------------------------------
Fax | 205-590-1120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JENNIFER METCALF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-590-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 113797
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------