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General NPI Number Information
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NPI Number | 1043269137
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Entity Type | Individual
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Provider Name | JAY P HANEY DOCTOR OF PHARMACY
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 8500 W CAPITOL DR
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City | MILWAUKEE
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State | WI
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Zip | 53222-1869
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Country | US
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Telephone | 414-463-1111
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Fax | 414-463-1112
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Provider Business Mailing Address
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Address Line | W319N1019 BALSAM LN
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City | DELAFIELD
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State | WI
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Zip | 53018-2633
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Country | US
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Telephone | 262-719-5346
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13310-040
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License Number State | WI
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