Provider Demographics
NPI:1659656320
Name:HANNA, KELLY ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ELIZABETH
Last Name:HANNA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1142
Mailing Address - Country:US
Mailing Address - Phone:410-706-4102
Mailing Address - Fax:
Practice Address - Street 1:20 N PINE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1142
Practice Address - Country:US
Practice Address - Phone:410-706-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist