Provider Demographics
NPI:1346498094
Name:HAHN, PHYLLIS A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:A
Last Name:HAHN
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 1:344 N MACKINAW RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48634-9549
Mailing Address - Country:US
Mailing Address - Phone:989-697-5205
Mailing Address - Fax:989-697-5205
Practice Address - Street 1:344 N MACKINAW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:MI
Practice Address - Zip Code:48634-9549
Practice Address - Country:US
Practice Address - Phone:989-697-5205
Practice Address - Fax:989-697-5205
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-07
Last Update Date:2008-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019167183500000X
CO13470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist