Provider Demographics
NPI:1316668882
Name:PALACIO, HAYES
Entity type:Individual
Prefix:MR
First Name:HAYES
Middle Name:
Last Name:PALACIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 COUNTY ROAD 45
Mailing Address - Street 2:
Mailing Address - City:MAPLESVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36750-3649
Mailing Address - Country:US
Mailing Address - Phone:334-322-7590
Mailing Address - Fax:
Practice Address - Street 1:520 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6231
Practice Address - Country:US
Practice Address - Phone:334-322-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist