Individual
TODD CARLTON HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3250 MIDWAY DR, AMMON, ID 83406-7650
(208) 552-7677
Mailing address
1102 KILLARNEY AVE, IDAHO FALLS, ID 83404-6845
(208) 390-9100
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5256
ID
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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