Provider Demographics
NPI:1427924125
Name:HANSON, AUDREY HOANG
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:HOANG
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4627 BELMONT AVE # 104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3422
Mailing Address - Country:US
Mailing Address - Phone:210-454-6697
Mailing Address - Fax:
Practice Address - Street 1:5809 E LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4324
Practice Address - Country:US
Practice Address - Phone:214-750-3210
Practice Address - Fax:214-750-3229
Is Sole Proprietor?:No
Enumeration Date:2025-10-11
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist