Provider Demographics
NPI:1912132713
Name:BAAGIL, IEMAAN HASAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:IEMAAN
Middle Name:HASAN
Last Name:BAAGIL
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 1:240 E GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0460
Mailing Address - Country:US
Mailing Address - Phone:980-320-0160
Mailing Address - Fax:980-320-0161
Practice Address - Street 1:240 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0460
Practice Address - Country:US
Practice Address - Phone:980-320-0160
Practice Address - Fax:980-320-0161
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist