=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124730452
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALEY DAWNE MINK PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2022
-----------------------------------------------------
Last Update Date | 12/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5555 YOUNGSTOWN WARREN RD
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44446-4804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-505-9463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3670 DEMURA DR SE
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44484-3722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-531-1083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03442720
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------