Provider Demographics
NPI:1063852416
Name:O'HAGAN, CHARLES J (PHARMD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:O'HAGAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 MARICOPA DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8266
Mailing Address - Country:US
Mailing Address - Phone:847-302-3195
Mailing Address - Fax:
Practice Address - Street 1:1465 MARICOPA DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8266
Practice Address - Country:US
Practice Address - Phone:847-302-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-30
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist