Provider Demographics
NPI:1043269137
Name:HANEY, JAY P (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:P
Last Name:HANEY
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:P
Other - Last Name:HANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCTOR OF PHARMACY
Mailing Address - Street 1:W319N1019 BALSAM LN
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2633
Mailing Address - Country:US
Mailing Address - Phone:262-719-5346
Mailing Address - Fax:
Practice Address - Street 1:8500 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1869
Practice Address - Country:US
Practice Address - Phone:414-463-1111
Practice Address - Fax:414-463-1112
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13310-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528311933Medicaid
WIFZ3541299OtherDEA
WIBA9613515OtherDEA NUMBER
WI33286600Medicaid
WI0532850175Medicare ID - Type UnspecifiedMEDICARE NUMBER