Provider Demographics
NPI:1508470980
Name:HOAG, NICHOLAS ROBERT (PHARM D, RPH)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ROBERT
Last Name:HOAG
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 REX AVE APT 157
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5925
Mailing Address - Country:US
Mailing Address - Phone:314-630-0816
Mailing Address - Fax:
Practice Address - Street 1:2737 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-7907
Practice Address - Country:US
Practice Address - Phone:417-358-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019033481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist