Provider Demographics
NPI:1295857456
Name:HANNAS DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:HANNAS DISCOUNT PHARMACY
Other - Org Name:HANNAS MEDICAL EQUIPMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:RPH OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:SR
Authorized Official - Credentials:BS RPH
Authorized Official - Phone:803-625-4185
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:BOX 1088
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-1088
Mailing Address - Country:US
Mailing Address - Phone:803-625-4185
Mailing Address - Fax:803-625-2443
Practice Address - Street 1:26 EAST RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-1088
Practice Address - Country:US
Practice Address - Phone:803-625-4185
Practice Address - Fax:803-625-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDME725332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC50002223OtherPHARMACY PERMIT
SC6617OtherRPH LISCENSE #
SCDME725Medicaid
SC4215617Medicaid
SC6617OtherRPH LISCENSE #
SC=========OtherFED TAX ID OR EIN
SC4879410001Medicare ID - Type UnspecifiedMEDICARE PART B SUPPLIER