Provider Demographics
NPI:1174924245
Name:HANNA, BICHOY GEORGE SAMY
Entity type:Individual
Prefix:
First Name:BICHOY
Middle Name:GEORGE SAMY
Last Name:HANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15714 PISSARO TER
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3480
Mailing Address - Country:US
Mailing Address - Phone:703-314-0804
Mailing Address - Fax:
Practice Address - Street 1:15100 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4602
Practice Address - Country:US
Practice Address - Phone:301-776-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist