Provider Demographics
NPI:1114384062
Name:BLANK, HANNAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 FAIR OAKS BLVD
Mailing Address - Street 2:STE 101-317
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 LENNON LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2414
Practice Address - Country:US
Practice Address - Phone:925-412-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist