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General NPI Number Information
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NPI Number | 1740718725
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Entity Type | Individual
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Provider Name | HAIDEN MOHL PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2017
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Last Update Date | 06/02/2017
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Provider Practice Location Address
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Address Line | 401 W POPLAR ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-2846
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Country | US
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Telephone | 509-897-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 232 NE CEDAR AVE # B
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City | COLLEGE PLACE
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State | WA
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Zip | 99324-1161
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Country | US
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Telephone | 406-239-1052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PHA-PHA-LIC-39576
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60672106
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License Number State | WA
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