Individual
PAIGE HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
2438 STAFFORD DR, AMMON, ID 83401-5879
(208) 705-5009
Mailing address
2438 STAFFORD DR, AMMON, ID 83401-5879
(208) 705-5009
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P6661
ID
Other
Enumeration date
01/06/2014
Last updated
01/06/2014
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