MEDICARE: DR. RYAN N HANSEN PHARM.D.

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	PH00051750	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PH00051750	OTHER	WA	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1588651541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN N HANSEN PHARM.D.

Provider Business Mailing Address
First Line	:	3551 NE 92ND ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-3661
Country	:	US
Telephone Number	:	206-930-9985
Fax Number	:	206-448-4406

Provider Business Practice Location Address
First Line	:	2324 EASTLAKE AVE E
Second Line	:	SUITE 405
City	:	SEATTLE
State	:	WA
Zip	:	98102-3345
Country	:	US
Telephone Number	:	206-441-9174
Fax Number	:	206-448-4406

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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