Healthcare Provider Details

I. General information

NPI: 1902319981
Provider Name (Legal Business Name): HANSA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SE FEDERAL HWY STE 122
STUART FL
34994-3802
US

IV. Provider business mailing address

1111 SE FEDERAL HWY STE 122
STUART FL
34994-3802
US

V. Phone/Fax

Practice location:
  • Phone: 772-617-7684
  • Fax: 772-617-6782
Mailing address:
  • Phone: 772-617-6784
  • Fax: 772-617-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHIRANJIVI B JANNU
Title or Position: OWNER
Credential:
Phone: 646-673-0044