Provider Demographics
NPI:1962032920
Name:HANSON, MARY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2027
Mailing Address - Country:US
Mailing Address - Phone:563-359-5313
Mailing Address - Fax:
Practice Address - Street 1:1823 E KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2027
Practice Address - Country:US
Practice Address - Phone:563-359-5313
Practice Address - Fax:563-344-8563
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist