Provider Demographics
NPI:1841774569
Name:HANSEN, ROBERT JEREL (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEREL
Last Name:HANSEN
Suffix:
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 1:1633 LOWER MONITOR RD
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-9021
Mailing Address - Country:US
Mailing Address - Phone:801-910-6651
Mailing Address - Fax:
Practice Address - Street 1:1633 LOWER MONITOR RD
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-9021
Practice Address - Country:US
Practice Address - Phone:801-910-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT348872-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist