Provider Demographics
NPI:1548380017
Name:HANNA, CHRIS MICHAEL SR (BS, RPH)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:MICHAEL
Last Name:HANNA
Suffix:SR
Gender:M
Credentials:BS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-1088
Mailing Address - Country:US
Mailing Address - Phone:803-625-4185
Mailing Address - Fax:803-625-2443
Practice Address - Street 1:26 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-1088
Practice Address - Country:US
Practice Address - Phone:803-625-4185
Practice Address - Fax:803-625-2443
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4215617Medicaid
SC6617OtherPHARMACY LISCENSE #
SC50002223OtherPHARMACY PERMIT #
SC582283523OtherFED TAX ID OR EMPLOYER ID
SCDME725Medicaid
SC4879410001Medicare ID - Type UnspecifiedMEDICARE PT B PROVIDER #
SC4215617Medicaid