Provider Demographics
NPI:1316331952
Name:JAMES A.HALEY VA HOSPITAL
Entity type:Organization
Organization Name:JAMES A.HALEY VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RUBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-204-0376
Mailing Address - Street 1:6465 142ND AVE N APT X205
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-2785
Mailing Address - Country:US
Mailing Address - Phone:727-204-0376
Mailing Address - Fax:
Practice Address - Street 1:6465 142ND AVE N APT X205
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-2785
Practice Address - Country:US
Practice Address - Phone:727-204-0376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10032382261QV0200X
FLRPT 52320261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA