Provider Demographics
NPI:1013086222
Name:TADROS, HANNY M (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HANNY
Middle Name:M
Last Name:TADROS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6165 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-1749
Mailing Address - Country:US
Mailing Address - Phone:714-846-0688
Mailing Address - Fax:714-846-7083
Practice Address - Street 1:611 S BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3580
Practice Address - Country:US
Practice Address - Phone:714-778-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH42160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist