Healthcare Provider Details

I. General information

NPI: 1730092362
Provider Name (Legal Business Name): MIRA HANNA RPH, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 E LOS COYOTES DIAGONAL
LONG BEACH CA
90815-2840
US

IV. Provider business mailing address

5009 E LOS COYOTES DIAGONAL
LONG BEACH CA
90815-2840
US

V. Phone/Fax

Practice location:
  • Phone: 562-360-9166
  • Fax:
Mailing address:
  • Phone: 562-360-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: