Provider Demographics
NPI:1376938951
Name:HANSON, JESS (PHARM D)
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:
Last Name:HANSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5736
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5736
Mailing Address - Country:US
Mailing Address - Phone:605-978-3900
Mailing Address - Fax:888-868-8660
Practice Address - Street 1:2503 E 54TH ST N
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5563
Practice Address - Country:US
Practice Address - Phone:605-978-3900
Practice Address - Fax:888-868-8660
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5061OtherPHARMACY LICENSE