MEDICARE: DEVAN 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	183500000X	Pharmacist	S020654	AZ

General Provider Information

NPI Number	:	1366859498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVAN HANSEN PHARMD

Provider Business Mailing Address
First Line	:	1130 W SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-4993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 W SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-4993
Country	:	US
Telephone Number	:	480-461-1193
Fax Number	:

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

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/21/2014

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Directions to “ DEVAN HANSEN PHARMD” Practice Location

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