Provider Demographics
NPI:1699300368
Name:PITERA, HANAKO HIROSE (R PH)
Entity type:Individual
Prefix:
First Name:HANAKO
Middle Name:HIROSE
Last Name:PITERA
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PAA KO DR
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-8501
Mailing Address - Country:US
Mailing Address - Phone:505-286-2665
Mailing Address - Fax:
Practice Address - Street 1:3728 N PRINCE ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9744
Practice Address - Country:US
Practice Address - Phone:575-769-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist