Provider Demographics
NPI:1447392824
Name:HAYDON-GREATTING, STARLIN ANN (RPH)
Entity type:Individual
Prefix:
First Name:STARLIN
Middle Name:ANN
Last Name:HAYDON-GREATTING
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 1:3601 MELISSA DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-9600
Mailing Address - Country:US
Mailing Address - Phone:217-793-0278
Mailing Address - Fax:217-793-7798
Practice Address - Street 1:3601 MELISSA DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-9600
Practice Address - Country:US
Practice Address - Phone:217-793-0278
Practice Address - Fax:217-793-7798
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist