Provider Demographics
NPI:1215160973
Name:HAILE, DAVID LAWRENCE (BS, RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:HAILE
Suffix:
Gender:M
Credentials:BS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-8601
Mailing Address - Country:US
Mailing Address - Phone:610-670-9986
Mailing Address - Fax:610-370-9376
Practice Address - Street 1:4810 PENN AVE
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-8601
Practice Address - Country:US
Practice Address - Phone:610-670-9986
Practice Address - Fax:610-370-9376
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042159L183500000X
PARPI000066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP042159LOtherREGISTERED PHARMACIST - PA
PARPI000066OtherAUTHORIZATION TO ADMINISTER INJECTABLES - PA