Provider Demographics
NPI:1629288071
Name:HAGAN, UNCHONG SPENCER (RPH)
Entity Type:Individual
Prefix:
First Name:UNCHONG
Middle Name:SPENCER
Last Name:HAGAN
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:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:MD
Mailing Address - Zip Code:21765-0054
Mailing Address - Country:US
Mailing Address - Phone:443-927-1788
Mailing Address - Fax:
Practice Address - Street 1:6 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3407
Practice Address - Country:US
Practice Address - Phone:410-951-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist