Provider Demographics
NPI:1932421286
Name:HANLON, MICHAEL J (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:HANLON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 E KANESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1004
Mailing Address - Country:US
Mailing Address - Phone:712-325-0987
Mailing Address - Fax:712-328-9629
Practice Address - Street 1:2803 EAST KANESVILLE BOULEVARD
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51534
Practice Address - Country:US
Practice Address - Phone:712-325-0987
Practice Address - Fax:712-328-9629
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA141221835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist