Provider Demographics
NPI:1003247024
Name:HANSEN, RYAN ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ALAN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 NW KLINE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5552
Mailing Address - Country:US
Mailing Address - Phone:541-517-2746
Mailing Address - Fax:
Practice Address - Street 1:1377 NE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2159
Practice Address - Country:US
Practice Address - Phone:541-672-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-01
Last Update Date:2013-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist