=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922185925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER GUTHRIE HAGOOD PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 CURRY HWY
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35503-7542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-221-6811
-----------------------------------------------------
Fax | 205-295-1751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3003 RIDGEBROOK DR
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35504-6962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-221-6811
-----------------------------------------------------
Fax | 205-295-1750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 14366
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------