Active NPI
Jacqueline Hanson, RPH
- Pharmacist
- Fennimore, WI
National Provider Identifier
1164955563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11885-40
- Practice address
- 1120 Lincoln Ave
Fennimore, WI 53809 - Phone
- (608) 822-3601
- NPI assigned
- Apr 4, 2017
- Last updated
- Apr 4, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11885-40 | WI | Primary |
Addresses
Primary practice location
1120 Lincoln Ave
Fennimore, WI 53809
Mailing address
22514 Thiede Rd
Muscoda, WI 53573
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11885-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hartig Drug Co Corp | Past | Accepting new patients | |
| Hartig Drug Co Corp | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Retail Pharmacy
- Fennimore, WI
- NPI 1316044985
-
- Long Term Care Pharmacy
- Waukon, IA
- NPI 1740592591
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491264000000",
"number": "1164955563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22514 THIEDE RD",
"city": "MUSCODA",
"state": "WI",
"postal_code": "53573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 LINCOLN AVE",
"city": "FENNIMORE",
"state": "WI",
"postal_code": "53809",
"telephone_number": "608-822-3601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSON",
"first_name": "JACQUELINE",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-04",
"last_updated": "2017-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "11885-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fennimore, WI
- Stephanie Elin Foster
- Ashlyn Jo Boebel Fritche
- Kylee Gardner, PTA
- Grant Regional Health Center, Inc (Grant Regional Community Clinic- Fennimore)
- GTN Fennimore, Inc. (Southwest Counseling)
- Hartig Drug Co Corp
- Amanda Lee Haugrud, PTA
- High Point Family Medicine, LLC
- Nicole M Kaiser, LCSW
- Lori Lynn Kartman
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.