Provider Demographics
NPI:1477523611
Name:HANEKE, ROBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HANEKE
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 1:31619 W LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SYLVIA
Mailing Address - State:KS
Mailing Address - Zip Code:67581-9275
Mailing Address - Country:US
Mailing Address - Phone:620-486-2432
Mailing Address - Fax:
Practice Address - Street 1:31619 W LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:SYLVIA
Practice Address - State:KS
Practice Address - Zip Code:67581-9275
Practice Address - Country:US
Practice Address - Phone:620-486-2432
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-098141835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy