Provider Demographics
NPI:1396292736
Name:HANSON, CONNOR (RPH)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:
Last Name:HANSON
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 1:328 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1517
Mailing Address - Country:US
Mailing Address - Phone:920-748-5174
Mailing Address - Fax:
Practice Address - Street 1:328 WATSON ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1517
Practice Address - Country:US
Practice Address - Phone:920-748-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI#18341-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist