Provider Demographics
NPI:1306956644
Name:HAGA CORPORATION
Entity type:Organization
Organization Name:HAGA CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/RPH
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-467-2232
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:MILLERSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43046
Mailing Address - Country:US
Mailing Address - Phone:740-467-2232
Mailing Address - Fax:740-467-2938
Practice Address - Street 1:12075 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:MILLERSPORT
Practice Address - State:OH
Practice Address - Zip Code:43046
Practice Address - Country:US
Practice Address - Phone:740-467-2232
Practice Address - Fax:740-467-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0207850503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0668344Medicaid
OH1283750001Medicare ID - Type Unspecified