Provider Demographics
NPI:1437406394
Name:HAGERMAN, AMANDA NOEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NOEL
Last Name:HAGERMAN
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 1:14025 ROCKET BOYS DR
Mailing Address - Street 2:
Mailing Address - City:WAR
Mailing Address - State:WV
Mailing Address - Zip Code:24892-9401
Mailing Address - Country:US
Mailing Address - Phone:304-875-2330
Mailing Address - Fax:304-875-2332
Practice Address - Street 1:14025 ROCKET BOYS DR
Practice Address - Street 2:
Practice Address - City:WAR
Practice Address - State:WV
Practice Address - Zip Code:24892-9401
Practice Address - Country:US
Practice Address - Phone:304-875-2330
Practice Address - Fax:304-875-2332
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211420183500000X
WVRP0007940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist