Provider Demographics
NPI:1780025999
Name:HANSEN, ROGER ERIC (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ERIC
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2669
Mailing Address - Country:US
Mailing Address - Phone:503-945-2944
Mailing Address - Fax:503-947-1085
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2669
Practice Address - Country:US
Practice Address - Phone:503-945-2944
Practice Address - Fax:503-947-1085
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist