MEDICARE: WILLIAM HAGUE 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	333600000X	Pharmacy	PHY 50305	CA
2	3336C0004X	Compounding Pharmacy	PHY 50305	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY 50305	OTHER	CA	BOARD OF PHARMACY PERMIT

General Provider Information

NPI Number	:	1427377993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM HAGUE INC

Provider Business Mailing Address
First Line	:	18134 MT WASHINGTON ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6121
Country	:	US
Telephone Number	:	714-444-2800
Fax Number	:	714-444-2810

Provider Business Practice Location Address
First Line	:	18134 MT WASHINGTON ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6121
Country	:	US
Telephone Number	:	714-444-2800
Fax Number	:	714-444-2810

Authorized Official
Title or Position	:	PRESIDENT/PIC
Name	:	MR. CURTIS WILLIAM HAGUE
Credential	:	RPH
Telephone Number	:	714-444-2800

Provider Enumeration Date	:	05/24/2010
Last Update Date	:	10/20/2010

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