Provider Demographics
NPI:1629519392
Name:HANSEN, WILLIAM LEE JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LEE
Last Name:HANSEN
Suffix:JR
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 1:7228 OAK LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8185
Mailing Address - Country:US
Mailing Address - Phone:734-347-0362
Mailing Address - Fax:
Practice Address - Street 1:905 NEBRASKA AVE
Practice Address - Street 2:STE Q
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-4222
Practice Address - Country:US
Practice Address - Phone:567-694-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist