Provider Demographics
NPI:1255927158
Name:HAYNES, DAMIAN LAMARK (RPH)
Entity type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:LAMARK
Last Name:HAYNES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 HIGHWAY 96 S
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-5509
Mailing Address - Country:US
Mailing Address - Phone:409-385-5276
Mailing Address - Fax:409-385-6333
Practice Address - Street 1:685 HIGHWAY 96 S
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-5509
Practice Address - Country:US
Practice Address - Phone:409-385-5276
Practice Address - Fax:409-385-6333
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX61288OtherRPH