MEDICARE: DR. MARY E. HAILER PHARMD, RPH.

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	1835P1200X	Pharmacotherapy Pharmacist	03-3-10588	OH

General Provider Information

NPI Number	:	1639257652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E. HAILER PHARMD, RPH.

Provider Business Mailing Address
First Line	:	4466 SALSBURY LN
Second Line	:
City	:	STOW
State	:	OH
Zip	:	44224-5207
Country	:	US
Telephone Number	:	330-375-3375
Fax Number	:	330-375-7622

Provider Business Practice Location Address
First Line	:	525 E. MARKET ST
Second Line	:	PHARMACY DEPT.
City	:	AKRON
State	:	OH
Zip	:	44309-2090
Country	:	US
Telephone Number	:	330-375-3375
Fax Number	:	330-375-7622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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