Healthcare Provider Details

I. General information

NPI: 1972598738
Provider Name (Legal Business Name): HANNA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13221 TAMIAMI TRAIL
NORTH PORT FL
34287
US

IV. Provider business mailing address

13221 TAMIAMI TRAIL
NORTH PORT FL
34287
US

V. Phone/Fax

Practice location:
  • Phone: 941-426-1123
  • Fax: 941-423-2827
Mailing address:
  • Phone: 941-426-1123
  • Fax: 941-423-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH6625
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TULSIBEN PATEL
Title or Position: PHARMACY OWNER
Credential:
Phone: 941-426-1123