Basic Information
| Provider Information | |||||||||
| NPI: | 1003153065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANNOUSH | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | SUMMERS | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1825 PARKER RD SE | ||||||||
| Address2: | APARTMENT 322 | ||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300942603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049834891 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2159 HIGHWAY 20 SE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300132028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709182506 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2013 | ||||||||
| LastUpdateDate: | 01/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH026618 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.