Provider Demographics
NPI:1104497296
Name:MORDORSKI, HAYLEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HAYLEY
Middle Name:
Last Name:MORDORSKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HAYLEY
Other - Middle Name:
Other - Last Name:KYTTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4166 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-6106
Mailing Address - Country:US
Mailing Address - Phone:612-262-6679
Mailing Address - Fax:
Practice Address - Street 1:4166 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-6106
Practice Address - Country:US
Practice Address - Phone:651-483-5461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist