Provider Demographics
NPI:1912541772
Name:HANSON, ALESIA LYNNE
Entity Type:Individual
Prefix:
First Name:ALESIA
Middle Name:LYNNE
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 S PRESIDENTS DR STE B
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-7244
Mailing Address - Country:US
Mailing Address - Phone:801-978-9600
Mailing Address - Fax:801-880-4799
Practice Address - Street 1:2233 S PRESIDENTS DR STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-7244
Practice Address - Country:US
Practice Address - Phone:801-978-9600
Practice Address - Fax:801-880-4799
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT287187-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist