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NPI 1922376433

NPI 1922376433 : CRAYTON C HAYES RPH : PUEBLO, CO

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General NPI Number Information
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    NPI Number           |    1922376433
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    Entity Type          |    Individual 
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    Provider Name        |    CRAYTON C HAYES RPH
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    12/12/2011
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    Last Update Date     |    12/12/2011
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Provider Practice Location Address
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    Address Line         |    1520 W 4TH ST 
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    City                 |    PUEBLO
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    State                |    CO
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    Zip                  |    81004-1207
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    Country              |    US
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    Telephone            |    719-404-0069
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    Fax                  |    719-404-0072
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Provider Business Mailing Address
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    Address Line         |    1520 W 4TH ST 
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    City                 |    PUEBLO
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    State                |    CO
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    Zip                  |    81004-1207
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    Country              |    US
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    Telephone            |    719-404-0069
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    Fax                  |    719-404-0072
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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       |    9675
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    License Number State |    CO
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