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General NPI Number Information
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NPI Number | 1245378231
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Entity Type | Organization
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Legal Business Name | JOHN THOMAS HAINES
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 1701 S 2ND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1907
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Country | US
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Telephone | 215-389-4148
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Fax | 215-389-0296
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Provider Business Mailing Address
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Address Line | 1701 S 2ND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1907
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Country | US
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Telephone | 215-389-4148
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Fax | 215-389-0296
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | JOHN HAINES
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Credential | RPH
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Telephone | 215-389-4148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP411633L
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License Number State | PA
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