Provider Demographics
NPI:1699882522
Name:HASSON, JAN E (RPH)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:E
Last Name:HASSON
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 1:946 E BUCCANEER DR
Mailing Address - Street 2:
Mailing Address - City:WINNIE
Mailing Address - State:TX
Mailing Address - Zip Code:77665-8903
Mailing Address - Country:US
Mailing Address - Phone:409-296-4461
Mailing Address - Fax:409-296-4461
Practice Address - Street 1:3420 VETERANS CIR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2552
Practice Address - Country:US
Practice Address - Phone:409-981-8570
Practice Address - Fax:409-981-8569
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27182183500000X
OK10539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist