Provider Demographics
NPI:1154608313
Name:HANSEN, RONALD WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WAYNE
Last Name:HANSEN
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 1:2519 S NEWCOMBE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2762
Mailing Address - Country:US
Mailing Address - Phone:303-523-1605
Mailing Address - Fax:303-989-4454
Practice Address - Street 1:10808 W JEWELL AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6266
Practice Address - Country:US
Practice Address - Phone:303-914-1088
Practice Address - Fax:303-914-1106
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13947183500000X
AZS014047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist