Provider Demographics
NPI:1063792018
Name:HAYDEN FAMILY PHARMACY P C
Entity type:Organization
Organization Name:HAYDEN FAMILY PHARMACY P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-590-1100
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35079-0665
Mailing Address - Country:US
Mailing Address - Phone:205-590-1100
Mailing Address - Fax:205-590-1120
Practice Address - Street 1:88 WHITE OAK TRL
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-4214
Practice Address - Country:US
Practice Address - Phone:205-590-1100
Practice Address - Fax:205-590-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1137973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01D2107084OtherCLIA
2131605OtherPK
AL1063792018Medicaid