Provider Demographics
NPI:1508899840
Name:HAGGEN, INC
Entity Type:Organization
Organization Name:HAGGEN, INC
Other - Org Name:HAGGEN FOOD & PHARMACY, TOP FOOD & DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, PHAR
Authorized Official - Prefix:MR
Authorized Official - First Name:GAETANO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DIPASQUA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-650-8204
Mailing Address - Street 1:2211 RIMLAND DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-733-8720
Mailing Address - Fax:360-752-6437
Practice Address - Street 1:21900 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8038
Practice Address - Country:US
Practice Address - Phone:425-672-1520
Practice Address - Fax:425-672-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4261333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6012074Medicaid
4922440OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WA6012074Medicaid