Provider Demographics
NPI:1821544271
Name:HANSON, JORDAN RANDALL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:RANDALL
Last Name:HANSON
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 1:3001 E HIGHWAY 7
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-4556
Mailing Address - Country:US
Mailing Address - Phone:320-269-5496
Mailing Address - Fax:320-269-8575
Practice Address - Street 1:3001 E HIGHWAY 7
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-4556
Practice Address - Country:US
Practice Address - Phone:320-269-5496
Practice Address - Fax:320-269-8575
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist