Provider Demographics
NPI:1467275420
Name:HANSEN, VERLYNN KATHRYN (RPH)
Entity type:Individual
Prefix:
First Name:VERLYNN
Middle Name:KATHRYN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:VERLYNN
Other - Middle Name:KATHRYN
Other - Last Name:SHETLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:776 S WOOD BRIAR WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-3339
Mailing Address - Country:US
Mailing Address - Phone:801-381-6437
Mailing Address - Fax:
Practice Address - Street 1:776 S WOOD BRIAR WAY
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-3339
Practice Address - Country:US
Practice Address - Phone:801-381-6437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT272700-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist