Provider Demographics
NPI:1295020857
Name:HEENAN, DANIEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HEENAN
Suffix:
Gender:M
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 1:6025 WADE HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5334
Mailing Address - Country:US
Mailing Address - Phone:864-879-9721
Mailing Address - Fax:864-879-9721
Practice Address - Street 1:6025 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5334
Practice Address - Country:US
Practice Address - Phone:864-879-9721
Practice Address - Fax:864-879-9721
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist