Provider Demographics
NPI:1013153733
Name:HANNON, CHRISTOPHER (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:HANNON
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 1:526 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PURLING
Mailing Address - State:NY
Mailing Address - Zip Code:12470-2711
Mailing Address - Country:US
Mailing Address - Phone:518-782-0227
Mailing Address - Fax:
Practice Address - Street 1:873 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2150
Practice Address - Country:US
Practice Address - Phone:518-782-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051190-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist