=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861425100
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAGGEN, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 10/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1406 LAKE TAPPS PKWY E
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98092-8154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-876-1761
-----------------------------------------------------
Fax | 253-876-1795
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2211 RIMLAND DRIVE SUITE 300
-----------------------------------------------------
City | BELLINGHAM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-733-8720
-----------------------------------------------------
Fax | 360-752-6437
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT, PHAR
-----------------------------------------------------
Name | MR. GAETANO (GUY) ANTHONY DIPASQUA
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 360-650-8204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 57366
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------