Basic Information
| Provider Information | |||||||||
| NPI: | 1255902177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANOCHTEN | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | VAN OCHTEN | ||||||||
| OtherFirstName: | HANNAH | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | PHARMD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 19825 SWEETWATER CURV | ||||||||
| Address2: | |||||||||
| City: | SHOREWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553318123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528073763 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 760 HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941071235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158361700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2021 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 183500000X | 84858 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.