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NPI Code Detail

MEDICARE: HAGGEN OPCO NORTH LLC

MEDICARE: HAGGEN OPCO NORTH LLC
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
13336C0003XCommunity/Retail Pharmacy60536174WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12150687OTHERPK

General Provider Information

NPI Number : 1457307845
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAGGEN OPCO NORTH LLC
Provider Business Mailing Address
First Line : 2211 RIMLAND DR
Second Line : STE 300
City : BELLINGHAM
State : WA
Zip : 98226-5664
Country : US
Telephone Number : 360-733-8720
Fax Number : 360-752-6437
Provider Business Practice Location Address
First Line : 3925 236TH AVE NE
Second Line :
City : REDMOND
State : WA
Zip : 98053-8455
Country : US
Telephone Number : 425-836-8706
Fax Number : 425-836-8728
Authorized Official
Title or Position : CORPORATE SENIOR VICE PRESIDENT, PH
Name : GAETANO DIPASQUA
Credential :
Telephone Number : 360-650-8204
Provider Enumeration Date : 05/26/2006
Last Update Date : 06/10/2015

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Directions to “HAGGEN OPCO NORTH LLC ” Practice Location

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