MEDICARE: DR. JASON S HANEY PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	11792	SC

General Provider Information

NPI Number	:	1154850576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON S HANEY PHARMD

Provider Business Mailing Address
First Line	:	280 CALHOUN ST.
Second Line	:	QE 218, MSC 140
City	:	CHARLESTON
State	:	SC
Zip	:	29425
Country	:	US
Telephone Number	:	843-792-5150
Fax Number	:	843-792-3759

Provider Business Practice Location Address
First Line	:	25 COURTENAY DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8906
Country	:	US
Telephone Number	:	843-792-5150
Fax Number	:

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

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	07/21/2022

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