Healthcare Provider Details

I. General information

NPI: 1124432059
Provider Name (Legal Business Name): MARK HAGAR JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 NORTH ST
CALAIS ME
04619-1619
US

IV. Provider business mailing address

18 BIRCH LN
ALEXANDER ME
04694-6306
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-2262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR12981
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: