Healthcare Provider Details

I. General information

NPI: 1629629423
Provider Name (Legal Business Name): STEPHANIE KAREN HANSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63802 US HIGHWAY 93 STE B
RONAN MT
59864-3414
US

IV. Provider business mailing address

2701 CORRECTIONVILLE RD
SIOUX CITY IA
51105-3627
US

V. Phone/Fax

Practice location:
  • Phone: 406-676-5600
  • Fax: 406-676-5632
Mailing address:
  • Phone: 712-258-0113
  • Fax: 712-258-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23179
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83287
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: