Healthcare Provider Details

I. General information

NPI: 1497378863
Provider Name (Legal Business Name): ERIN N HANSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN N DICKMAN

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 S LIMESTONE ST
SPRINGFIELD OH
45505-1965
US

IV. Provider business mailing address

651 S LIMESTONE ST
SPRINGFIELD OH
45505-1965
US

V. Phone/Fax

Practice location:
  • Phone: 937-324-1111
  • Fax: 937-525-4543
Mailing address:
  • Phone: 937-324-1111
  • Fax: 937-525-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03439731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: