MEDICARE: MRS. SHARON GAIL HAGAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	045048	MO

General Provider Information

NPI Number	:	1336139096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON GAIL HAGAN RPH

Provider Business Mailing Address
First Line	:	1143 DOGWOOD RD
Second Line	:
City	:	LAKE OZARK
State	:	MO
Zip	:	65049-6418
Country	:	US
Telephone Number	:	573-365-7102
Fax Number	:	573-392-4425

Provider Business Practice Location Address
First Line	:	101 S MAPLE ST
Second Line	:
City	:	ELDON
State	:	MO
Zip	:	65026-1850
Country	:	US
Telephone Number	:	573-392-4588
Fax Number	:	573-392-4425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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Directions to “ MRS. SHARON GAIL HAGAN RPH” Practice Location

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