Healthcare Provider Details

I. General information

NPI: 1508470980
Provider Name (Legal Business Name): NICHOLAS ROBERT HOAG PHARM D., RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 S GRAND AVE
CARTHAGE MO
64836-7907
US

IV. Provider business mailing address

1715 REX AVE APT 157
JOPLIN MO
64801-5925
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-4321
  • Fax:
Mailing address:
  • Phone: 314-630-0816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2019033481
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: