Provider Demographics
NPI:1457706525
Name:HANAN, WILLIAM KEITH (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KEITH
Last Name:HANAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 LOS OSOS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3203
Mailing Address - Country:US
Mailing Address - Phone:805-528-1447
Mailing Address - Fax:805-528-5510
Practice Address - Street 1:1199 LOS OSOS VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3203
Practice Address - Country:US
Practice Address - Phone:805-528-1447
Practice Address - Fax:805-528-5510
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist