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General NPI Number Information
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NPI Number | 1255867289
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Entity Type | Individual
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Provider Name | BENJAMIN HANSEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 09/03/2018
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Provider Practice Location Address
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Address Line | 2150 COUNTRY CLUB RD STE 300
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City | WINSTON SALEM
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State | NC
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Zip | 27104
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Country | US
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Telephone | 336-718-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 150 PETERS CREEK PKWY APT 209
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City | WINSTON SALEM
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State | NC
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Zip | 27101-3684
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Country | US
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Telephone | 828-234-3420
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 25983
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License Number State | NC
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