Provider Demographics
NPI:1912416702
Name:SANE, JONI KINSEY (RPH)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:KINSEY
Last Name:SANE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:CELESTE
Other - Last Name:KINSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 PALMETTO WOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2881
Mailing Address - Country:US
Mailing Address - Phone:877-936-1045
Mailing Address - Fax:877-936-9735
Practice Address - Street 1:2 PALMETTO WOOD PKWY
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2881
Practice Address - Country:US
Practice Address - Phone:877-936-1045
Practice Address - Fax:877-936-9735
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9422OtherSTATE LICENSE NUMBER