MEDICARE: DR. DONALD BRUCE HANSEN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	5092	CT

General Provider Information

NPI Number	:	1053381152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD BRUCE HANSEN PHARMD

Provider Business Mailing Address
First Line	:	1650 COCHRANE CIRCLE ATTN. CREDENTIALS OFFICE
Second Line	:	USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL
City	:	FT. CARSON
State	:	CO
Zip	:	80913-4604
Country	:	US
Telephone Number	:	719-526-7844
Fax Number	:	719-526-7984

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIRCLE ATTN. PHARMACY
Second Line	:	USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL
City	:	FT. CARSON
State	:	CO
Zip	:	80913-4604
Country	:	US
Telephone Number	:	719-526-7844
Fax Number	:	719-526-7984

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/08/2007

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