MEDICARE: JONI KINSEY SANE RPH

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	183500000X	Pharmacist	9422	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9422	OTHER	SC	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1912416702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONI KINSEY SANE RPH

Provider Business Mailing Address
First Line	:	2 PALMETTO WOOD PKWY
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2881
Country	:	US
Telephone Number	:	877-936-1045
Fax Number	:	877-936-9735

Provider Business Practice Location Address
First Line	:	2 PALMETTO WOOD PKWY
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2881
Country	:	US
Telephone Number	:	877-936-1045
Fax Number	:	877-936-9735

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

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	09/25/2017

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