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NPI Code Detail

MEDICARE: MR. DARRYL WAYNE HAILEY

MEDICARE: MR. DARRYL WAYNE HAILEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist33341TX

General Provider Information

NPI Number : 1104154061
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DARRYL WAYNE HAILEY
Provider Business Mailing Address
First Line : 8430 BROADWAY ST
Second Line :
City : PEARLAND
State : TX
Zip : 77584-7883
Country : US
Telephone Number : 281-412-3305
Fax Number : 281-412-2191
Provider Business Practice Location Address
First Line : 8430 BROADWAY ST
Second Line :
City : PEARLAND
State : TX
Zip : 77584-7883
Country : US
Telephone Number : 281-412-3305
Fax Number : 281-412-2191
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2009
Last Update Date : 12/03/2009

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Directions to “ MR. DARRYL WAYNE HAILEY ” Practice Location

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