Healthcare Provider Details

I. General information

NPI: 1184052805
Provider Name (Legal Business Name): JUMANA B HANNA BS PHARAMCY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CARSON TOWN CENTER KMART 4987 PHARMACY
CARSON CA
90745
US

IV. Provider business mailing address

PO BOX 9483
FOUNTAIN VALLEY CA
92728-9483
US

V. Phone/Fax

Practice location:
  • Phone: 310-533-1899
  • Fax: 310-533-0207
Mailing address:
  • Phone: 714-962-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45842
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043158-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: