Provider Demographics
NPI:1124398755
Name:HANA, GEMY A (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:GEMY
Middle Name:A
Last Name:HANA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 FOROUGH CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6026
Mailing Address - Country:US
Mailing Address - Phone:352-278-1819
Mailing Address - Fax:
Practice Address - Street 1:1625 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6925
Practice Address - Country:US
Practice Address - Phone:386-761-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist