Provider Demographics
NPI:1124690730
Name:HAUSMANN, ROGER DANA II (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DANA
Last Name:HAUSMANN
Suffix:II
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:MR
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:HAUSMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACY TECHNICIAN
Mailing Address - Street 1:2620 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3041
Mailing Address - Country:US
Mailing Address - Phone:408-241-0919
Mailing Address - Fax:408-241-1202
Practice Address - Street 1:2620 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-3041
Practice Address - Country:US
Practice Address - Phone:408-241-0919
Practice Address - Fax:408-241-1202
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA159365183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA159365OtherPHARMACY TECNICIAN LICENSE