Provider Demographics
NPI:1932423613
Name:HANSEN, ELIZABETH CORAZZO (RPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CORAZZO
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 STUTTS RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6402
Mailing Address - Country:US
Mailing Address - Phone:704-799-0078
Mailing Address - Fax:704-799-0063
Practice Address - Street 1:136 STUTTS RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6402
Practice Address - Country:US
Practice Address - Phone:704-799-0078
Practice Address - Fax:704-799-0063
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15374183500000X
CT9004183500000X
FLPS34588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist