Provider Demographics
NPI:1144393695
Name:HAGEN, LYNN L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:L
Last Name:HAGEN
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 1:1120 E 34TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2909
Mailing Address - Country:US
Mailing Address - Phone:218-263-7455
Mailing Address - Fax:218-263-9155
Practice Address - Street 1:1120 E 34TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2909
Practice Address - Country:US
Practice Address - Phone:218-263-7455
Practice Address - Fax:218-263-9155
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112043-9183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist