Provider Demographics
NPI:1396815155
Name:HANSEN, BRENDA C (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:C
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S. MAIN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006
Mailing Address - Country:US
Mailing Address - Phone:509-276-2939
Mailing Address - Fax:509-276-3061
Practice Address - Street 1:810 S. MAIN
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-276-2939
Practice Address - Fax:509-276-3061
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000190311835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy