Provider Demographics
NPI:1255610036
Name:HANNA, JESSICA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:HANNA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CR 804
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:CO
Mailing Address - Zip Code:80442-1394
Mailing Address - Country:US
Mailing Address - Phone:970-726-6920
Mailing Address - Fax:
Practice Address - Street 1:40 CR 804
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:CO
Practice Address - Zip Code:80442
Practice Address - Country:US
Practice Address - Phone:970-726-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist