Healthcare Provider Details

I. General information

NPI: 1295828465
Provider Name (Legal Business Name): JC HANSEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 E MAIN ST
EDMORE MI
48829-9346
US

IV. Provider business mailing address

326 E MAIN ST
EDMORE MI
48829-0019
US

V. Phone/Fax

Practice location:
  • Phone: 989-427-5275
  • Fax: 989-427-5973
Mailing address:
  • Phone: 989-427-5275
  • Fax: 989-427-5973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301005863
License Number StateMI

VIII. Authorized Official

Name: JEFFREY AL HANSEN
Title or Position: PRESIDENT
Credential:
Phone: 989-427-5275