Provider Demographics
NPI:1356561070
Name:HAYES, EDMUND MICHAEL (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:MICHAEL
Last Name:HAYES
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 OLD TOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2604
Mailing Address - Country:US
Mailing Address - Phone:631-828-1890
Mailing Address - Fax:
Practice Address - Street 1:243 OLD TOWN ROAD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2604
Practice Address - Country:US
Practice Address - Phone:631-828-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist