Provider Demographics
NPI:1700513934
Name:HANNA, MARK ONSY HANNA ANIS
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ONSY HANNA ANIS
Last Name:HANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 GLEIM CT
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1494
Mailing Address - Country:US
Mailing Address - Phone:717-562-6761
Mailing Address - Fax:
Practice Address - Street 1:4299 UNION DEPOSIT RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2802
Practice Address - Country:US
Practice Address - Phone:717-564-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist