Individual
MR. JACK S. HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16300 SE EVELYN ST, CLACKAMAS, OR 97015-9515
(888) 255-2269
Mailing address
16300 SE EVELYN ST, CLACKAMAS, OR 97015-9515
(888) 255-2269
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10537
OR
Other
Enumeration date
02/26/2011
Last updated
02/26/2011
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