Provider Demographics
NPI:1982853461
Name:HANNAN, TIMOTHY CHARLES (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:HANNAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 BLUE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-3960
Mailing Address - Country:US
Mailing Address - Phone:724-553-5660
Mailing Address - Fax:
Practice Address - Street 1:20111 ROUTE 19 STE 22
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6207
Practice Address - Country:US
Practice Address - Phone:724-776-2988
Practice Address - Fax:724-776-0298
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAR2152124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist