Provider Demographics
NPI:1013433275
Name:HANSEN, HOLLY JOY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:JOY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10946 DEBLIN LN
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5062
Mailing Address - Country:US
Mailing Address - Phone:708-856-7622
Mailing Address - Fax:
Practice Address - Street 1:11000 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5504
Practice Address - Country:US
Practice Address - Phone:708-346-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-19
Last Update Date:2017-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist