Provider Demographics
NPI:1912288267
Name:HANNA, NYDIA RODRIGUEZ (RPH PHD)
Entity Type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:RODRIGUEZ
Last Name:HANNA
Suffix:
Gender:F
Credentials:RPH PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3299 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3833
Mailing Address - Country:US
Mailing Address - Phone:770-218-8588
Mailing Address - Fax:770-218-7797
Practice Address - Street 1:3299 CANTON RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3833
Practice Address - Country:US
Practice Address - Phone:770-218-8588
Practice Address - Fax:770-218-7797
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH16606183500000X
SC5091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist