Provider Demographics
NPI:1174269062
Name:HANSON, HOLLY G (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:G
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6132 MARBLE RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8735
Mailing Address - Country:US
Mailing Address - Phone:218-270-2233
Mailing Address - Fax:
Practice Address - Street 1:417 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2806
Practice Address - Country:US
Practice Address - Phone:218-828-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1187501835P0018X
AK13611835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist