Provider Demographics
NPI:1255572319
Name:HANAIE, JACOB (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:HANAIE
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 1:8631 CLIFTON WAY
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2105
Mailing Address - Country:US
Mailing Address - Phone:818-631-1000
Mailing Address - Fax:877-866-2770
Practice Address - Street 1:8631 CLIFTON WAY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2105
Practice Address - Country:US
Practice Address - Phone:818-631-1000
Practice Address - Fax:877-866-2770
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH59992183500000X, 1835P0018X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric