Provider Demographics
NPI:1194749093
Name:HAGAN, JOHN STEPHENS (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEPHENS
Last Name:HAGAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1973 HYGEIA RD
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-5218
Mailing Address - Country:US
Mailing Address - Phone:615-643-0071
Mailing Address - Fax:615-384-4562
Practice Address - Street 1:511 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2905
Practice Address - Country:US
Practice Address - Phone:615-384-4561
Practice Address - Fax:615-384-4562
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist