Provider Demographics
NPI:1649388315
Name:HAYES, ELISA LYNNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:LYNNE
Last Name:HAYES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 THURSTON STREET
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1621
Mailing Address - Country:US
Mailing Address - Phone:508-384-5160
Mailing Address - Fax:
Practice Address - Street 1:205 THURSTON STREET
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1621
Practice Address - Country:US
Practice Address - Phone:508-384-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19033183500000X
MAPH190331835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist