MEDICARE: JOHN THOMAS HAINES

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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP411633L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3912804	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1245378231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN THOMAS HAINES

Provider Business Mailing Address
First Line	:	1701 S 2ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1907
Country	:	US
Telephone Number	:	215-389-4148
Fax Number	:	215-389-0296

Provider Business Practice Location Address
First Line	:	1701 S 2ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1907
Country	:	US
Telephone Number	:	215-389-4148
Fax Number	:	215-389-0296

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	JOHN HAINES
Credential	:	RPH
Telephone Number	:	215-389-4148

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	11/10/2011

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Directions to “JOHN THOMAS HAINES ” Practice Location

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