Provider Demographics
NPI:1366571283
Name:HAGAN, MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HAGAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:MD
Mailing Address - Zip Code:21765-0054
Mailing Address - Country:US
Mailing Address - Phone:443-927-1788
Mailing Address - Fax:
Practice Address - Street 1:111 MICHIGAN AVENUE NW, 4 MAIN SUITE 4847
Practice Address - Street 2:DIVISION OF PHARMACY - CHILDREN'S NATIONAL HOSPITAL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:301-572-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist