Provider Demographics
NPI:1386874246
Name:HAYNES, JESSICA PENSON (PHARM D)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PENSON
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WEST MAIN STREET
Mailing Address - Street 2:SPINDALE DRUG CO INC
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160
Mailing Address - Country:US
Mailing Address - Phone:828-286-2836
Mailing Address - Fax:828-286-8509
Practice Address - Street 1:109 WEST MAIN S
Practice Address - Street 2:SPINDALE DRUG CO INC
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160
Practice Address - Country:US
Practice Address - Phone:828-286-2836
Practice Address - Fax:828-286-8509
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist