Provider Demographics
NPI:1205167012
Name:HOGAN, STACIE (RPH)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:HOGAN
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 1:815 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-9735
Mailing Address - Country:US
Mailing Address - Phone:910-893-4544
Mailing Address - Fax:910-893-4544
Practice Address - Street 1:815 W FRONT ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9735
Practice Address - Country:US
Practice Address - Phone:910-893-4544
Practice Address - Fax:910-893-4544
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist