Provider Demographics
NPI:1134433246
Name:HAYNES, ROBERT WESLEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WESLEY
Last Name:HAYNES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GREENVILLE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5707
Mailing Address - Country:US
Mailing Address - Phone:252-756-1611
Mailing Address - Fax:252-756-1623
Practice Address - Street 1:103 GREENVILLE BLVD SE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5707
Practice Address - Country:US
Practice Address - Phone:252-756-1611
Practice Address - Fax:252-756-1623
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21342OtherREGISTERED PHARMACIST LICENSE