Provider Demographics
NPI:1174745319
Name:PHAN, HANNA (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:HANNA
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 NORTH MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743
Mailing Address - Country:US
Mailing Address - Phone:520-626-0050
Mailing Address - Fax:520-626-7355
Practice Address - Street 1:1295 NORTH MARTIN AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743
Practice Address - Country:US
Practice Address - Phone:520-626-0050
Practice Address - Fax:520-626-7355
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS106950183500000X
MI5302032705183500000X
OH03127770183500000X
AZ3091082 BCPS CERT1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy