=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437554128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE HAYNES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2014
-----------------------------------------------------
Last Update Date | 10/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 322 HIGHWAY 463 S
-----------------------------------------------------
City | TRUMANN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72472-2146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-483-6325
-----------------------------------------------------
Fax | 870-483-6483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 524
-----------------------------------------------------
City | ARKADELPHIA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71923-0524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-246-5553
-----------------------------------------------------
Fax | 870-245-1790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PD07004
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------