Provider Demographics
NPI:1194033555
Name:HANEY, TRELLIS M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRELLIS
Middle Name:M
Last Name:HANEY
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 1:107 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-2635
Mailing Address - Country:US
Mailing Address - Phone:662-369-0060
Mailing Address - Fax:662-369-6324
Practice Address - Street 1:107 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-2635
Practice Address - Country:US
Practice Address - Phone:662-369-0060
Practice Address - Fax:662-369-6324
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE7660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist