Provider Demographics
NPI:1093010886
Name:HANSEN, RICHARD E (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
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 1:116 RIVER OAKS RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3246
Mailing Address - Country:US
Mailing Address - Phone:864-469-9364
Mailing Address - Fax:
Practice Address - Street 1:3518 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7553
Practice Address - Country:US
Practice Address - Phone:864-220-1380
Practice Address - Fax:864-295-2617
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist