Provider Demographics
NPI:1043619562
Name:HANSON, ALLISON SUZANNE (PHARMD, BCPS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:SUZANNE
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARKER AVE APT 2205
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4463
Mailing Address - Country:US
Mailing Address - Phone:248-802-0658
Mailing Address - Fax:
Practice Address - Street 1:1 PARKER AVE APT 2205
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-4463
Practice Address - Country:US
Practice Address - Phone:248-802-0658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist