Basic Information
| Provider Information | |||||||||
| NPI: | 1295282762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYDEN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 NYS RT 12 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA BAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154826270 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21 NYS RT 12 | ||||||||
| Address2: | |||||||||
| City: | ALEX BAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136071816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154826270 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 061931 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.