Provider Demographics
NPI:1326098294
Name:REAGAN PHARMACY, INC.
Entity Type:Organization
Organization Name:REAGAN PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:O'NEAL
Authorized Official - Last Name:HAGLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-588-3109
Mailing Address - Street 1:111 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36344-1647
Mailing Address - Country:US
Mailing Address - Phone:334-588-3109
Mailing Address - Fax:334-588-0669
Practice Address - Street 1:111 W MILL ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:AL
Practice Address - Zip Code:36344-1647
Practice Address - Country:US
Practice Address - Phone:334-588-3109
Practice Address - Fax:334-588-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1083203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0107412OtherNABP
AL100000556Medicaid
ALBR3051442OtherDEA
AL100000556Medicaid