MEDICARE: MR. RICHARD E HANSEN RPH

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	183500000X	Pharmacist	4130	SC

General Provider Information

NPI Number	:	1093010886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD E HANSEN RPH

Provider Business Mailing Address
First Line	:	116 RIVER OAKS RD
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-3246
Country	:	US
Telephone Number	:	864-469-9364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 HIGHWAY 153
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-7553
Country	:	US
Telephone Number	:	864-220-1380
Fax Number	:	864-295-2617

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

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	01/25/2011

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