Healthcare Provider Details

I. General information

NPI: 1154809739
Provider Name (Legal Business Name): CHRISTINA ELEANOR HANSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 PEACH ST
ERIE PA
16509-2603
US

IV. Provider business mailing address

1858 W GRANDVIEW BLVD
ERIE PA
16509-1025
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-4031
  • Fax:
Mailing address:
  • Phone: 814-866-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP451369
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: