Provider Demographics
NPI:1467725408
Name:HANNA, WANDA ANDERSON (RPH)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:ANDERSON
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 1:1117 POLK ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2524
Mailing Address - Country:US
Mailing Address - Phone:318-871-2976
Mailing Address - Fax:866-575-1502
Practice Address - Street 1:1117 POLK ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2524
Practice Address - Country:US
Practice Address - Phone:318-871-2976
Practice Address - Fax:866-575-1502
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13327OtherLOUISIANA BOARD OF PHARMACY