Provider Demographics
NPI:1225637440
Name:HANNA, MINA F (RPH)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:F
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 1:60 BLACKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1305
Mailing Address - Country:US
Mailing Address - Phone:401-368-8822
Mailing Address - Fax:401-368-8822
Practice Address - Street 1:60 BLACKSTONE ST
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1305
Practice Address - Country:US
Practice Address - Phone:401-368-8822
Practice Address - Fax:401-368-8822
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05678183500000X, 1835P0018X
MAPH234955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist