1033434949 NPI number — MR. DON ENNIS HOGAN RPH

Table of content: (NPI 1336144757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033434949 NPI number — MR. DON ENNIS HOGAN RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOGAN
Provider First Name:
DON
Provider Middle Name:
ENNIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1033434949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 WESOBULGA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINEVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36266-4743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-396-5675
Provider Business Mailing Address Fax Number:
256-354-1246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83825 HIGHWAY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36251-7981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-354-1160
Provider Business Practice Location Address Fax Number:
256-354-1246
Provider Enumeration Date:
04/02/2010

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:  5645 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5645 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com