Provider Demographics
NPI:1386719680
Name:HAYNES, KATHLEEN BLANTON (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BLANTON
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N RITTER AVE
Mailing Address - Street 2:SUITE #211
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3052
Mailing Address - Country:US
Mailing Address - Phone:317-355-6915
Mailing Address - Fax:317-355-6916
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:SUITE #211
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3052
Practice Address - Country:US
Practice Address - Phone:317-355-6915
Practice Address - Fax:317-355-6916
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020671A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy