Provider Demographics
NPI:1083907604
Name:HASSAN, HASSAN MANA
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:MANA
Last Name:HASSAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12521 TRISKETT RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2526
Mailing Address - Country:US
Mailing Address - Phone:716-316-5540
Mailing Address - Fax:
Practice Address - Street 1:15149 SNOW RD
Practice Address - Street 2:
Practice Address - City:BROOK PARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2458
Practice Address - Country:US
Practice Address - Phone:216-676-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist