Provider Demographics
NPI:1588874218
Name:HAN, MIRABELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:MIRABELLE
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3546
Mailing Address - Country:US
Mailing Address - Phone:530-756-3393
Mailing Address - Fax:530-759-7809
Practice Address - Street 1:655 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3546
Practice Address - Country:US
Practice Address - Phone:530-756-3393
Practice Address - Fax:530-759-7809
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist