Provider Demographics
NPI:1841503372
Name:HANEY, PAUL WILLIAM (PHARM D)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:WILLIAM
Last Name:HANEY
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:PO BOX 3233
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-3233
Mailing Address - Country:US
Mailing Address - Phone:360-275-5596
Mailing Address - Fax:
Practice Address - Street 1:23940 NE STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9697
Practice Address - Country:US
Practice Address - Phone:360-275-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00043336183500000X
NE11012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist