Provider Demographics
NPI:1164978847
Name:DEVORE, HANNAH BREANNE (RPH)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:BREANNE
Last Name:DEVORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9680 MUSKET BALL CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5387
Mailing Address - Country:US
Mailing Address - Phone:802-881-7638
Mailing Address - Fax:
Practice Address - Street 1:12405 BRANDON ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3589
Practice Address - Country:US
Practice Address - Phone:907-646-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK113669OtherPHARMACY LICENSE