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General NPI Number Information
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NPI Number | 1629113105
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Entity Type | Organization
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Legal Business Name | HALEY DRUG
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 102 S COMMERCIAL ST
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City | TEMPLE
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State | OK
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Zip | 73568-0130
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Country | US
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Telephone | 580-342-6691
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Fax | 580-342-6452
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | TEMPLE
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State | OK
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Zip | 73568-0130
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Country | US
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Telephone | 580-342-6691
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Fax | 580-342-6452
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | DR. KENNETH WAYNE HALEY
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Credential | DPH
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Telephone | 580-342-6691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 651293
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License Number State | OK
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