Provider Demographics
NPI:1588268825
Name:HANEY, JUSTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:HANEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 E 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2854
Mailing Address - Country:US
Mailing Address - Phone:913-538-5019
Mailing Address - Fax:913-538-5025
Practice Address - Street 1:1453 E 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2854
Practice Address - Country:US
Practice Address - Phone:913-538-5019
Practice Address - Fax:913-538-5025
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015029222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist