Provider Demographics
NPI:1083041784
Name:HANNA, JOSEPH K (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:K
Last Name:HANNA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 MR JOE WHIE AVE
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577
Mailing Address - Country:US
Mailing Address - Phone:843-445-7179
Mailing Address - Fax:843-445-7786
Practice Address - Street 1:1946 MR JOE WHITE AVE
Practice Address - Street 2:SAM'S CLUB
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6278
Practice Address - Country:US
Practice Address - Phone:843-445-7179
Practice Address - Fax:843-445-7786
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11849OtherPHARMACY LICENSE