Provider Demographics
NPI:1043836075
Name:HANSEN, MELISSA ROSE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1038
Mailing Address - Country:US
Mailing Address - Phone:419-294-3469
Mailing Address - Fax:
Practice Address - Street 1:429 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-1038
Practice Address - Country:US
Practice Address - Phone:419-294-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist