=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013153733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER HANNON PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2008
-----------------------------------------------------
Last Update Date | 12/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 873 NEW LOUDON RD
-----------------------------------------------------
City | LATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12110-2150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-782-0227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 526 MOUNTAIN AVE
-----------------------------------------------------
City | PURLING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12470-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-782-0227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051190-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------