Provider Demographics
NPI:1497358584
Name:HANNA, MARKO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARKO
Middle Name:
Last Name:HANNA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARKO
Other - Middle Name:
Other - Last Name:ATTALLA HANNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8524 HANNARY CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4092
Mailing Address - Country:US
Mailing Address - Phone:850-960-2755
Mailing Address - Fax:
Practice Address - Street 1:2668 CRAWFORDVILLE HWY
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-2160
Practice Address - Country:US
Practice Address - Phone:850-926-3541
Practice Address - Fax:850-926-2364
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist