Provider Demographics
NPI:1689607921
Name:HAGGEN INC
Entity Type:Organization
Organization Name:HAGGEN INC
Other - Org Name:TOP 75
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-650-8316
Mailing Address - Street 1:1213 E WISHKAH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-4224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1213 E WISHKAH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4224
Practice Address - Country:US
Practice Address - Phone:360-532-8742
Practice Address - Fax:360-532-8792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58437333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4931653OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WA6028815Medicaid
WA0471030039Medicare NSC