Healthcare Provider Details

I. General information

NPI: 1316998339
Provider Name (Legal Business Name): VICKY L HANSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 E 10TH AVE
ANCHORAGE AK
99501-4003
US

IV. Provider business mailing address

PO BOX 771405
EAGLE RIVER AK
99577-1405
US

V. Phone/Fax

Practice location:
  • Phone: 907-792-2315
  • Fax: 907-257-4687
Mailing address:
  • Phone: 907-792-2315
  • Fax: 907-257-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberAA944
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: