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General NPI Number Information
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NPI Number | 1619341302
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Entity Type | Individual
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Provider Name | MINA HANNA
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Gender | Male
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 2624 SUNSET AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3747
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Country | US
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Telephone | 252-937-4999
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Fax |
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Provider Business Mailing Address
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Address Line | 1914 ALEXANDER SPRINGS LN APT 18
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City | WAKE FOREST
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State | NC
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Zip | 27587-4030
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Country | US
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Telephone | 919-590-2152
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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 | 25536
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License Number State | NC
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