Provider Demographics
NPI:1467725903
Name:HANNA, THERESA (RPH)
Entity Type:Individual
Prefix:MS
First Name:THERESA
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 1:1801 10TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5384
Mailing Address - Country:US
Mailing Address - Phone:425-313-9200
Mailing Address - Fax:
Practice Address - Street 1:1801 10TH AVE NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5384
Practice Address - Country:US
Practice Address - Phone:425-313-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist