Provider Demographics
NPI:1972199107
Name:HANSON, JULIE DIANE (PHARM D)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:DIANE
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 GOOSE LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-9423
Mailing Address - Country:US
Mailing Address - Phone:612-419-5351
Mailing Address - Fax:
Practice Address - Street 1:8150 WEDGEWOOD LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-9400
Practice Address - Country:US
Practice Address - Phone:763-494-8355
Practice Address - Fax:763-494-8358
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN1166521835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care