Provider Demographics
NPI:1104716380
Name:HANNA, LARRY GEORGE (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GEORGE
Last Name:HANNA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9466
Mailing Address - Country:US
Mailing Address - Phone:904-463-1957
Mailing Address - Fax:
Practice Address - Street 1:5895 REIDVILLE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:SC
Practice Address - Zip Code:29369-8409
Practice Address - Country:US
Practice Address - Phone:864-486-6990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty