Provider Demographics
NPI:1689341745
Name:WOOTEN, HANNAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:WOOTEN
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 1:11344 CHARLES REYNOLDS LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3331
Mailing Address - Country:US
Mailing Address - Phone:847-732-0786
Mailing Address - Fax:
Practice Address - Street 1:2711 N TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8202
Practice Address - Country:US
Practice Address - Phone:575-521-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist