Provider Demographics
NPI:1174959936
Name:HANNA, NEVEEN A
Entity type:Individual
Prefix:
First Name:NEVEEN
Middle Name:A
Last Name:HANNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ELYSE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3315
Mailing Address - Country:US
Mailing Address - Phone:508-654-7873
Mailing Address - Fax:
Practice Address - Street 1:220 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-2117
Practice Address - Country:US
Practice Address - Phone:401-434-1333
Practice Address - Fax:401-435-4569
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05276183500000X
MAPH234517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist