Provider Demographics
NPI:1124397294
Name:HAGARTY, SUSAN E (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:HAGARTY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 ROBERTS RDG
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1178
Mailing Address - Country:US
Mailing Address - Phone:330-603-7739
Mailing Address - Fax:
Practice Address - Street 1:2645 STATE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1642
Practice Address - Country:US
Practice Address - Phone:330-928-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist