Provider Demographics
NPI:1033434949
Name:HOGAN, DON ENNIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:ENNIS
Last Name:HOGAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 WESOBULGA ST
Mailing Address - Street 2:
Mailing Address - City:LINEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36266-4743
Mailing Address - Country:US
Mailing Address - Phone:256-396-5675
Mailing Address - Fax:256-354-1246
Practice Address - Street 1:83825 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-7981
Practice Address - Country:US
Practice Address - Phone:256-354-1160
Practice Address - Fax:256-354-1246
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5645OtherPHARMACY LICENSE