Healthcare Provider Details

I. General information

NPI: 1750667119
Provider Name (Legal Business Name): KAREN SUE HAGEMEYER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13632 CLOVERDALE RD
BOWLING GREEN OH
43402-9547
US

IV. Provider business mailing address

13632 CLOVERDALE RD
BOWLING GREEN OH
43402-9547
US

V. Phone/Fax

Practice location:
  • Phone: 419-308-9900
  • Fax:
Mailing address:
  • Phone: 419-308-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number03-3-20087
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: