Provider Demographics
NPI:1336139096
Name:HAGAN, SHARON GAIL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:GAIL
Last Name:HAGAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-6418
Mailing Address - Country:US
Mailing Address - Phone:573-365-7102
Mailing Address - Fax:573-392-4425
Practice Address - Street 1:101 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1850
Practice Address - Country:US
Practice Address - Phone:573-392-4588
Practice Address - Fax:573-392-4425
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist