MEDICARE: DR. NYDIA RODRIGUEZ HANNA R.PH. PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH16606	GA
2	183500000X	Pharmacist	5091	SC

General Provider Information

NPI Number	:	1912288267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NYDIA RODRIGUEZ HANNA R.PH. PH.D.

Provider Business Mailing Address
First Line	:	3299 CANTON RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-3833
Country	:	US
Telephone Number	:	770-218-8588
Fax Number	:	770-218-7797

Provider Business Practice Location Address
First Line	:	3299 CANTON RD
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-3833
Country	:	US
Telephone Number	:	770-218-8588
Fax Number	:	770-218-7797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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