Individual
DR. CORY LANE HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-7051
Mailing address
434 N 2800 W, PROVO, UT 84601-5115
(801) 703-0554
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5039288-1701
UT
Other
Enumeration date
05/19/2007
Last updated
07/08/2007
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