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General NPI Number Information
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NPI Number | 1013631274
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Entity Type | Individual
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Provider Name | HANNA A MEKONNEN PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 4755 W ANN RD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-3424
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Country | US
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Telephone | 702-645-1360
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Fax | 702-396-8514
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Provider Business Mailing Address
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Address Line | 9883 MOUNT MADERA ST
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City | LAS VEGAS
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State | NV
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Zip | 89178-7518
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Country | US
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Telephone | 469-867-1576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 22895
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License Number State | NV
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