Provider Demographics
NPI:1285879718
Name:HAINES, ALLAN L (RPH)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:L
Last Name:HAINES
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 1:1357 RT 9
Mailing Address - Street 2:ALPINE COMMONS
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590
Mailing Address - Country:US
Mailing Address - Phone:845-298-7284
Mailing Address - Fax:845-298-1447
Practice Address - Street 1:1357 RT 9
Practice Address - Street 2:ALPINE COMMONS
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590
Practice Address - Country:US
Practice Address - Phone:845-298-7284
Practice Address - Fax:845-298-1447
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01985400Medicaid