Provider Demographics
NPI:1417516832
Name:HADEN, DANA M (RPH)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:HADEN
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 1:109 W LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75657-2205
Mailing Address - Country:US
Mailing Address - Phone:903-665-2521
Mailing Address - Fax:903-665-7422
Practice Address - Street 1:109 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:TX
Practice Address - Zip Code:75657-2205
Practice Address - Country:US
Practice Address - Phone:903-665-2521
Practice Address - Fax:903-665-7422
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist