Provider Demographics
NPI:1326321621
Name:HANNA, ENAS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ENAS
Middle Name:
Last Name:HANNA
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:PO BOX 351804
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-0227
Mailing Address - Country:US
Mailing Address - Phone:661-547-4649
Mailing Address - Fax:
Practice Address - Street 1:13851 GARVEY AVE
Practice Address - Street 2:STE A
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-4913
Practice Address - Country:US
Practice Address - Phone:626-851-9199
Practice Address - Fax:626-851-8053
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 55138OtherREGISTERED PHARMACIST LICENSE