Provider Demographics
NPI:1407463102
Name:HANSEN, ALYSSA (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61564 WOODFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-1535
Mailing Address - Country:US
Mailing Address - Phone:586-850-2988
Mailing Address - Fax:
Practice Address - Street 1:20877 HALL RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-4256
Practice Address - Country:US
Practice Address - Phone:586-464-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024129463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy