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General NPI Number Information
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NPI Number | 1417410309
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Entity Type | Individual
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Provider Name | SHANE EDWIN HANCOCK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 3895 HARRISON BLVD C/O 1ST FLOOR PHARMACY
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City | OGDEN
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State | UT
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Zip | 84403-8440
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Country | US
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Telephone | 801-387-8550
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Fax | 801-387-8555
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Provider Business Mailing Address
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Address Line | 3895 HARRISON BLVD C/O MCKAY-DEE NORTH CAMPUS PHARMACY
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City | OGDEN
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State | UT
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Zip | 84403-2312
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Country | US
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Telephone | 801-387-8550
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Fax | 801-387-8557
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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 | 7325645-1701
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License Number State | UT
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