Healthcare Provider Details

I. General information

NPI: 1104716380
Provider Name (Legal Business Name): LARRY GEORGE HANNA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5895 REIDVILLE RD
MOORE SC
29369-8409
US

IV. Provider business mailing address

220 W LAKEVIEW DR
DUNCAN SC
29334-9466
US

V. Phone/Fax

Practice location:
  • Phone: 864-486-6990
  • Fax:
Mailing address:
  • Phone: 904-463-1957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43318
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: