Provider Demographics
NPI:1114212826
Name:HANSON, JAMES M (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:HANSON
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 1:1300 RIVER VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1649
Mailing Address - Country:US
Mailing Address - Phone:740-681-1875
Mailing Address - Fax:740-681-1875
Practice Address - Street 1:1300 RIVER VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1649
Practice Address - Country:US
Practice Address - Phone:740-681-1875
Practice Address - Fax:740-681-1875
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18583183500000X
MN116284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist