Provider Demographics
NPI:1508454869
Name:HANEY, CORRINE (RPH)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:HANEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 E SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2856
Mailing Address - Country:US
Mailing Address - Phone:937-292-7902
Mailing Address - Fax:
Practice Address - Street 1:932 E SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2856
Practice Address - Country:US
Practice Address - Phone:937-292-7902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist