Provider Demographics
NPI:1942421631
Name:HAGEMEIER, NICHOLAS EDWARD (PHARMD, RPH)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:EDWARD
Last Name:HAGEMEIER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041
Mailing Address - Country:US
Mailing Address - Phone:765-659-3049
Mailing Address - Fax:765-482-1860
Practice Address - Street 1:112 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052
Practice Address - Country:US
Practice Address - Phone:765-482-0180
Practice Address - Fax:765-482-1860
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021091A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist