Provider Demographics
NPI:1770681702
Name:HANSON PHARMACY INC
Entity Type:Organization
Organization Name:HANSON PHARMACY INC
Other - Org Name:WHITESELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT MANAGER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-326-2004
Mailing Address - Street 1:11859 HG TRUEMAN RD
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-2855
Mailing Address - Country:US
Mailing Address - Phone:410-326-2004
Mailing Address - Fax:410-326-3393
Practice Address - Street 1:11859 HG TRUEMAN RD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2855
Practice Address - Country:US
Practice Address - Phone:410-326-2004
Practice Address - Fax:410-326-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP014453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113037OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MD543612500Medicaid