Provider Demographics
NPI:1114112661
Name:HAGNEY, GARY ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALAN
Last Name:HAGNEY
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 1:13098 OLD SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4040
Mailing Address - Country:US
Mailing Address - Phone:858-679-7727
Mailing Address - Fax:858-679-9401
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MAIL CODE 8765
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-3841
Practice Address - Fax:619-543-5829
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400461835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy