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General NPI Number Information
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NPI Number | 1194034710
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Entity Type | Individual
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Provider Name | PAUL ROBERT HANSEN PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 1310 JOHNSON LANE MARE ISLAND
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City | VALLEJO
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State | CA
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Zip | 94592
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Country | US
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Telephone | 804-754-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 6576 FRIARS RD APT. 105
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City | SAN DIEGO
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State | CA
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Zip | 92108-1000
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Country | US
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Telephone | 804-754-6118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 63493
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License Number State | CA
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