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General NPI Number Information
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NPI Number | 1578103016
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Entity Type | Individual
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Provider Name | MARK ALAN HOGAN JR. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 1140 N JEFFERSON ST
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City | OTTUMWA
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State | IA
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Zip | 52501-2017
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Country | US
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Telephone | 641-684-5467
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Fax | 641-683-8364
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Provider Business Mailing Address
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Address Line | 212 TERRACE DR
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City | OSKALOOSA
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State | IA
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Zip | 52577-4224
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Country | US
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Telephone | 563-249-7710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 22878
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License Number State | IA
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