MEDICARE: HAGGEN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	3151	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4918693	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245263581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAGGEN INC

Provider Business Mailing Address
First Line	:	1313 COOPER POINT RD SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 COOPER POINT RD SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5729
Country	:	US
Telephone Number	:	360-754-1504
Fax Number	:	360-754-1782

Authorized Official
Title or Position	:	VICE PRESIDENT PHARMACY
Name	:	MR. ANDREW J CHARTER
Credential	:	RPH
Telephone Number	:	360-650-8316

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	04/01/2009

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Directions to “HAGGEN INC ” Practice Location

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