Provider Demographics
NPI:1851669543
Name:HAGEN, RONALD S (RPH)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:S
Last Name:HAGEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482N OLD HIGHWAY 182
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552
Mailing Address - Country:US
Mailing Address - Phone:715-583-9944
Mailing Address - Fax:
Practice Address - Street 1:900 1ST AVE
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9467
Practice Address - Country:US
Practice Address - Phone:715-358-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8719-0401835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy