Provider Demographics
NPI:1619277191
Name:HANKINS, MICHAEL W (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:HANKINS
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 1:1500 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2208
Mailing Address - Country:US
Mailing Address - Phone:541-942-7443
Mailing Address - Fax:541-942-7139
Practice Address - Street 1:1500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2208
Practice Address - Country:US
Practice Address - Phone:541-942-7443
Practice Address - Fax:541-942-7139
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9280183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist