Provider Demographics
NPI:1366452559
Name:HANSON, EDWARD JULIUS (RPH)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JULIUS
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 1:514 LAKERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3913
Mailing Address - Country:US
Mailing Address - Phone:916-939-1773
Mailing Address - Fax:
Practice Address - Street 1:10540 WHITE ROCK RD STE 280
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6088
Practice Address - Country:US
Practice Address - Phone:916-463-9604
Practice Address - Fax:916-463-9750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist