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General NPI Number Information
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NPI Number | 1568005452
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Entity Type | Individual
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Provider Name | HANLON IGNATIUS MAIVELETT PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 420 POLIFKA DR
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City | SHAW AFB
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State | SC
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Zip | 29152-5100
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Country | US
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Telephone | 803-895-6466
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 ZEMKE AVE
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City | TAMPA
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State | FL
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Zip | 33621-5023
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Country | US
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Telephone | 813-828-9991
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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 | 42048
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License Number State | SC
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