Provider Demographics
NPI:1194005819
Name:KAGAN, DARA WHITNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:WHITNEY
Last Name:KAGAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 KESWICK MANOR DR
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1541
Mailing Address - Country:US
Mailing Address - Phone:561-706-4515
Mailing Address - Fax:
Practice Address - Street 1:115 VERNON ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3109
Practice Address - Country:US
Practice Address - Phone:706-812-9852
Practice Address - Fax:706-812-9937
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist