Healthcare Provider Details

I. General information

NPI: 1154419091
Provider Name (Legal Business Name): HANNA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 LONG BEACH BLVD.
LONG BEACH CA
90802-1323
US

IV. Provider business mailing address

653 LONG BEACH BLVD
LONG BEACH CA
90802-1323
US

V. Phone/Fax

Practice location:
  • Phone: 562-437-0678
  • Fax: 562-436-4601
Mailing address:
  • Phone: 201-377-8319
  • Fax: 562-436-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY14564
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAUL W HANNA
Title or Position: PRESIDENT/CEO/CFO/SEC./DIR.
Credential:
Phone: 201-377-8319