Provider Demographics
NPI:1376728683
Name:HANSON, JAMES W (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
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 1:237 MANDARIN DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8298
Mailing Address - Country:US
Mailing Address - Phone:601-829-9654
Mailing Address - Fax:601-829-3356
Practice Address - Street 1:3012 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3497
Practice Address - Country:US
Practice Address - Phone:601-939-4813
Practice Address - Fax:601-939-2749
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE 06741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist