MEDICARE: MR. BRETT E. HANEY RPH, BCPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1300X	Psychiatric Pharmacist	P4601	ID
2	1835P1300X	Psychiatric Pharmacist	PH00016660	WA

General Provider Information

NPI Number	:	1891792867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRETT E. HANEY RPH, BCPP

Provider Business Mailing Address
First Line	:	16788 W HOLLISTER HILLS DR
Second Line	:
City	:	HAUSER
State	:	ID
Zip	:	83854-6588
Country	:	US
Telephone Number	:	208-773-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	16788 W HOLLISTER HILLS DR
Second Line	:
City	:	HAUSER
State	:	ID
Zip	:	83854-6588
Country	:	US
Telephone Number	:	208-773-2412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/08/2007

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