Healthcare Provider Details

I. General information

NPI: 1508899840
Provider Name (Legal Business Name): HAGGEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21900 HIGHWAY 99
EDMONDS WA
98026-8038
US

IV. Provider business mailing address

2211 RIMLAND DRIVE SUITE 300
BELLINGHAM WA
98226
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-1520
  • Fax: 425-672-1538
Mailing address:
  • Phone: 360-733-8720
  • Fax: 360-752-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4261
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. GAETANO ANTHONY DIPASQUA
Title or Position: VICE PRESIDENT, PHAR
Credential: R.PH.
Phone: 360-650-8204