Healthcare Provider Details

I. General information

NPI: 1467725408
Provider Name (Legal Business Name): WANDA ANDERSON HANNA R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 POLK ST
MANSFIELD LA
71052-2524
US

IV. Provider business mailing address

1117 POLK ST
MANSFIELD LA
71052-2524
US

V. Phone/Fax

Practice location:
  • Phone: 318-871-2976
  • Fax: 866-575-1502
Mailing address:
  • Phone: 318-871-2976
  • Fax: 866-575-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13327
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: