Provider Demographics
NPI:1629629423
Name:HANSON, STEPHANIE KAREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAREN
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 CORRECTIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-3627
Mailing Address - Country:US
Mailing Address - Phone:712-258-0113
Mailing Address - Fax:712-258-0351
Practice Address - Street 1:63802 US HIGHWAY 93 STE B
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-3414
Practice Address - Country:US
Practice Address - Phone:406-676-5600
Practice Address - Fax:406-676-5632
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23179183500000X
MT83287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist