Provider Demographics
NPI:1548644909
Name:HANSEN, MATTHEW LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEE
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 E OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-4678
Mailing Address - Country:US
Mailing Address - Phone:801-663-1699
Mailing Address - Fax:
Practice Address - Street 1:5330 E WASHINGTON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2140
Practice Address - Country:US
Practice Address - Phone:801-663-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZI011980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist