Provider Demographics
NPI:1336756022
Name:ROQUE, HANNAH MINETTE MANGAHAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:HANNAH MINETTE
Middle Name:MANGAHAS
Last Name:ROQUE
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 1:1214 N BEALE RD
Mailing Address - Street 2:
Mailing Address - City:LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6283
Mailing Address - Country:US
Mailing Address - Phone:530-491-2727
Mailing Address - Fax:530-491-2728
Practice Address - Street 1:1214 N BEALE RD
Practice Address - Street 2:
Practice Address - City:LINDA
Practice Address - State:CA
Practice Address - Zip Code:95901-6283
Practice Address - Country:US
Practice Address - Phone:530-491-2727
Practice Address - Fax:530-491-2728
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83267183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty