Healthcare Provider Details

I. General information

NPI: 1275451338
Provider Name (Legal Business Name): ZACHARY HAGEDORN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 COMMERCE DR
LAFAYETTE IN
47905-3800
US

IV. Provider business mailing address

325 BROWN ST APT 1149
WEST LAFAYETTE IN
47906-3298
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-1278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26032066A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24667
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: