Provider Demographics
NPI:1447715842
Name:HAYNES, JOHN THOMAS (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
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 1:2044 LARCHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4952
Mailing Address - Country:US
Mailing Address - Phone:727-810-1900
Mailing Address - Fax:
Practice Address - Street 1:3320 SCHERER DR N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1003
Practice Address - Country:US
Practice Address - Phone:888-228-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist