Provider Demographics
NPI:1679105712
Name:HANNA, CHRISTINE (SENIOR CPHT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:SENIOR CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 S M 37
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-8508
Mailing Address - Country:US
Mailing Address - Phone:231-943-3147
Mailing Address - Fax:231-943-3462
Practice Address - Street 1:1029 S M 37
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-8508
Practice Address - Country:US
Practice Address - Phone:231-943-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303010668183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty