1194749093 NPI number — MR. JOHN STEPHENS HAGAN PHARMACIST

Table of content: RICHARD S JASLOW MD (NPI 1932169844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194749093 NPI number — MR. JOHN STEPHENS HAGAN PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGAN
Provider First Name:
JOHN
Provider Middle Name:
STEPHENS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194749093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1973 HYGEIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBRIER
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37073-5218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-643-0071
Provider Business Mailing Address Fax Number:
615-384-4562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 MEMORIAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37172-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-384-4561
Provider Business Practice Location Address Fax Number:
615-384-4562
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  3659 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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