Individual
SHANE EDWIN HANCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
3895 HARRISON BLVD, C/O 1ST FLOOR PHARMACY, OGDEN, UT 84403-8440
(801) 387-8550
(801) 387-8555
Mailing address
3895 HARRISON BLVD, C/O MCKAY-DEE NORTH CAMPUS PHARMACY, OGDEN, UT 84403-2312
(801) 387-8550
(801) 387-8557
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7325645-1701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7325645-1701
UTAH STATE PHARMACIST LICENSE
UT
01
—
7325645-8911
UTAH STATE PHARMACIST CONTROLLED SUBSTANCES LICENSE
UT
Enumeration date
04/09/2019
Last updated
04/09/2019
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