Provider Demographics
NPI:1568782878
Name:HATTAR, HANADI MARWAN
Entity Type:Individual
Prefix:
First Name:HANADI
Middle Name:MARWAN
Last Name:HATTAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28608 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7427
Mailing Address - Country:US
Mailing Address - Phone:951-240-5178
Mailing Address - Fax:
Practice Address - Street 1:25906 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-9130
Practice Address - Country:US
Practice Address - Phone:951-679-5199
Practice Address - Fax:951-672-6729
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist