Provider Demographics
NPI:1316998339
Name:HANSON, VICKY L (RPH)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:L
Last Name:HANSON
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:PO BOX 771405
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-1405
Mailing Address - Country:US
Mailing Address - Phone:907-792-2315
Mailing Address - Fax:907-257-4687
Practice Address - Street 1:1217 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4003
Practice Address - Country:US
Practice Address - Phone:907-792-2315
Practice Address - Fax:907-257-4687
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist