Provider Demographics
NPI:1275966491
Name:HANSEN, MELISSA MURRAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MURRAY
Last Name:HANSEN
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 1:343 W TRILBY ST
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-2142
Mailing Address - Country:US
Mailing Address - Phone:478-864-9717
Mailing Address - Fax:478-864-8006
Practice Address - Street 1:343 W TRILBY ST
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-2142
Practice Address - Country:US
Practice Address - Phone:478-864-9717
Practice Address - Fax:478-864-8006
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist