Provider Demographics
NPI:1316182413
Name:LAYTIN, WAYNE MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:MARK
Last Name:LAYTIN
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 1:288 LARKIN DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4911
Mailing Address - Country:US
Mailing Address - Phone:845-783-8116
Mailing Address - Fax:845-783-1288
Practice Address - Street 1:288 LARKIN DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4911
Practice Address - Country:US
Practice Address - Phone:845-783-8116
Practice Address - Fax:845-783-1288
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist