Provider Demographics
NPI:1891792867
Name:HANEY, BRETT E (RPH, BCPP)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:E
Last Name:HANEY
Suffix:
Gender:M
Credentials:RPH, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16788 W HOLLISTER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HAUSER
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6588
Mailing Address - Country:US
Mailing Address - Phone:208-773-2412
Mailing Address - Fax:
Practice Address - Street 1:16788 W HOLLISTER HILLS DR
Practice Address - Street 2:
Practice Address - City:HAUSER
Practice Address - State:ID
Practice Address - Zip Code:83854-6588
Practice Address - Country:US
Practice Address - Phone:208-773-2412
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP46011835P1300X
WAPH000166601835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric