Provider Demographics
NPI:1023434859
Name:HANSON, GREGG A
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:A
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4256
Mailing Address - Country:US
Mailing Address - Phone:203-729-2298
Mailing Address - Fax:203-723-4761
Practice Address - Street 1:155 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4256
Practice Address - Country:US
Practice Address - Phone:203-729-2298
Practice Address - Fax:203-723-4761
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6996183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician