Provider Demographics
NPI:1265823538
Name:HAGGEN OPCO NORTH, LLC
Entity Type:Organization
Organization Name:HAGGEN OPCO NORTH, LLC
Other - Org Name:HAGGEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SENIOR VP, PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:GAETANO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DIPASQUA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-650-8204
Mailing Address - Street 1:2211 RIMLAND DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5664
Mailing Address - Country:US
Mailing Address - Phone:360-733-8720
Mailing Address - Fax:360-752-6437
Practice Address - Street 1:2211 RIMLAND DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5664
Practice Address - Country:US
Practice Address - Phone:360-733-8720
Practice Address - Fax:360-752-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy