Healthcare Provider Details

I. General information

NPI: 1386476539
Provider Name (Legal Business Name): MICHAEL HANEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 LAFAYETTE CENTER DR STE 600
CHANTILLY VA
20151-1230
US

IV. Provider business mailing address

4151 LAFAYETTE CENTER DR STE 600
CHANTILLY VA
20151-1230
US

V. Phone/Fax

Practice location:
  • Phone: 703-230-4638
  • Fax:
Mailing address:
  • Phone: 571-498-9706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202222239
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: