Provider Demographics
NPI:1649942681
Name:HANEY, KENDALL KOREY (PHARMD)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:KOREY
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 1:41448 DAUBER WAY
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-5879
Mailing Address - Country:US
Mailing Address - Phone:770-846-3800
Mailing Address - Fax:
Practice Address - Street 1:40955 MERCHANTS LN
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3701
Practice Address - Country:US
Practice Address - Phone:301-475-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist