MEDICARE: ARDEN HANSON 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	22710	TX
2	183500000X	Pharmacist	5302021297	MI

General Provider Information

NPI Number	:	1154709509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARDEN HANSON RPH

Provider Business Mailing Address
First Line	:	1901 ROCKMOOR DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-2530
Country	:	US
Telephone Number	:	817-614-2283
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 ROCKMOOR DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-2530
Country	:	US
Telephone Number	:	817-614-2283
Fax Number	:

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

Provider Enumeration Date	:	05/18/2015
Last Update Date	:	05/18/2015

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