Individual
MARK RICHARD HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
312 S JAMES ST, GRAYLING, MI 49738-1818
(989) 348-1350
Mailing address
312 S. JAMES ST., RITE AID PHARMACY #02753, GRAYLING, MI 49738
(989) 348-1350
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302021293
MI
Other
Enumeration date
04/08/2011
Last updated
04/08/2011
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