Individual
GLORIA JEAN HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1570 E FAIRVIEW AVE, MERIDIAN, ID 83642-1821
(208) 888-0034
Mailing address
7717 W BRIGHT STAR ST, BOISE, ID 83709-8609
(208) 362-5552
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4667
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P4667
PHARMACY LICENSE NUMBER
ID
Enumeration date
10/18/2011
Last updated
10/18/2011
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