Provider Demographics
NPI:1184052805
Name:HANNA, JUMANA B (BS PHARAMCY)
Entity type:Individual
Prefix:MS
First Name:JUMANA
Middle Name:B
Last Name:HANNA
Suffix:
Gender:F
Credentials:BS PHARAMCY
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 9483
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-9483
Mailing Address - Country:US
Mailing Address - Phone:714-962-8388
Mailing Address - Fax:
Practice Address - Street 1:500 CARSON TOWN CENTER KMART 4987 PHARMACY
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-533-1899
Practice Address - Fax:310-533-0207
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45842183500000X
NY043158-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist