Healthcare Provider Details

I. General information

NPI: 1801925508
Provider Name (Legal Business Name): ANGELA HANSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BURDICK EXPY E
MINOT ND
58701-4768
US

IV. Provider business mailing address

12101 54TH AVE SW
BURLINGTON ND
58722-9515
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-7900
  • Fax:
Mailing address:
  • Phone: 701-340-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1590
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH4958
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: