1932283454 NPI number — DR. PHILLIP CHARLES HANN PHARM.D.

Table of content: DR. PHILLIP CHARLES HANN PHARM.D. (NPI 1932283454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932283454 NPI number — DR. PHILLIP CHARLES HANN PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANN
Provider First Name:
PHILLIP
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932283454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BODEGA BAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94923-0145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-875-9058
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3510 UNOCAL PL
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95403-0900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-547-1711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH 30273 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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