Provider Demographics
NPI:1467438598
Name:HANNON, ROSEANN LAURA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANN
Middle Name:LAURA
Last Name:HANNON
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 1:204 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-9283
Mailing Address - Country:US
Mailing Address - Phone:570-848-1862
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 6220
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-9062
Practice Address - Country:US
Practice Address - Phone:570-842-7848
Practice Address - Fax:570-842-2435
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040750L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist