Healthcare Provider Details

I. General information

NPI: 1336139096
Provider Name (Legal Business Name): SHARON GAIL HAGAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAPLE ST
ELDON MO
65026-1850
US

IV. Provider business mailing address

1143 DOGWOOD RD
LAKE OZARK MO
65049-6418
US

V. Phone/Fax

Practice location:
  • Phone: 573-392-4588
  • Fax: 573-392-4425
Mailing address:
  • Phone: 573-365-7102
  • Fax: 573-392-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number045048
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: