=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588384812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL THOMAS HAYES JR. PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2022
-----------------------------------------------------
Last Update Date | 08/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 BOULDER WAY
-----------------------------------------------------
City | BIDDEFORD
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04005-9442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-286-9562
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 HASKELL ST
-----------------------------------------------------
City | WESTBROOK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04092-4217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | PR71109
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------