Provider Demographics
NPI:1336418516
Name:HAGUE, TERRI GAUVEY (RPH)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:GAUVEY
Last Name:HAGUE
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 1:215 LANE 120 LONG LK
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:IN
Mailing Address - Zip Code:46737-9288
Mailing Address - Country:US
Mailing Address - Phone:260-316-5483
Mailing Address - Fax:
Practice Address - Street 1:215 LANE 120 LONG LK
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:IN
Practice Address - Zip Code:46737-9288
Practice Address - Country:US
Practice Address - Phone:260-316-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-18
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013045A183500000X
MI5302021486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist