Provider Demographics
NPI:1154532836
Name:HANNAH, LORING MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:LORING
Middle Name:MARK
Last Name:HANNAH
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:PO BOX 113
Mailing Address - Street 2:3851 MCINTYRE RD.
Mailing Address - City:MECKLENBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14863-0113
Mailing Address - Country:US
Mailing Address - Phone:607-330-2046
Mailing Address - Fax:
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1629
Practice Address - Country:US
Practice Address - Phone:607-737-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist