Provider Demographics
NPI:1194034710
Name:HANSEN, PAUL ROBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 FRIARS RD
Mailing Address - Street 2:APT. 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1000
Mailing Address - Country:US
Mailing Address - Phone:804-754-6118
Mailing Address - Fax:
Practice Address - Street 1:1310 JOHNSON LANE
Practice Address - Street 2:MARE ISLAND
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94592
Practice Address - Country:US
Practice Address - Phone:804-754-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA634931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist