Healthcare Provider Details

I. General information

NPI: 1659394336
Provider Name (Legal Business Name): KIMBERLY ANN HANSEN R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W UNION AVE
BOUND BROOK NJ
08805-1220
US

IV. Provider business mailing address

433 W UNION AVE
BOUND BROOK NJ
08805-1220
US

V. Phone/Fax

Practice location:
  • Phone: 732-356-3113
  • Fax: 732-356-6691
Mailing address:
  • Phone: 732-356-3113
  • Fax: 732-356-6691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02486500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: