Provider Demographics
NPI:1881807873
Name:HANSEN, MELISSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
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 1:3800 SE 22ND AVE
Mailing Address - Street 2:4002/35K
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2918
Mailing Address - Country:US
Mailing Address - Phone:503-797-5754
Mailing Address - Fax:
Practice Address - Street 1:3800 SE 22ND AVE
Practice Address - Street 2:4002/35K
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2918
Practice Address - Country:US
Practice Address - Phone:503-797-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118077183500000X
AKPHA P1553183500000X
WAPH00060754183500000X, 1835P0018X
ORRPH-00119881835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist