Provider Demographics
NPI:1073024212
Name:FENTA, HANNA
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:FENTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 GEORGIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3736
Mailing Address - Country:US
Mailing Address - Phone:301-562-7390
Mailing Address - Fax:
Practice Address - Street 1:8701 GEORGIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3736
Practice Address - Country:US
Practice Address - Phone:301-562-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist