Provider Demographics
NPI:1932283454
Name:HANN, PHILLIP CHARLES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:CHARLES
Last Name:HANN
Suffix:
Gender:M
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:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:BODEGA BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94923-0145
Mailing Address - Country:US
Mailing Address - Phone:707-875-9058
Mailing Address - Fax:
Practice Address - Street 1:3510 UNOCAL PL
Practice Address - Street 2:SUITE 109
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0900
Practice Address - Country:US
Practice Address - Phone:707-547-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 30273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist