Provider Demographics
NPI:1760797575
Name:HANKINS, MARTHA YVONNE (R PH)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:YVONNE
Last Name:HANKINS
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0535
Mailing Address - Country:US
Mailing Address - Phone:337-474-3050
Mailing Address - Fax:
Practice Address - Street 1:2000 GERTSNER MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8060
Practice Address - Country:US
Practice Address - Phone:337-439-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1897833Medicaid