Healthcare Provider Details

I. General information

NPI: 1194005819
Provider Name (Legal Business Name): DARA WHITNEY KAGAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 VERNON ST
LAGRANGE GA
30240-3109
US

IV. Provider business mailing address

138 KESWICK MANOR DR
TYRONE GA
30290-1541
US

V. Phone/Fax

Practice location:
  • Phone: 706-812-9852
  • Fax: 706-812-9937
Mailing address:
  • Phone: 561-706-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: