Provider Demographics
NPI:1386742542
Name:DAGOBERG, HAI (RPH)
Entity type:Individual
Prefix:MRS
First Name:HAI
Middle Name:
Last Name:DAGOBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6962 DERBY CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1563
Mailing Address - Country:US
Mailing Address - Phone:323-684-9798
Mailing Address - Fax:310-268-3070
Practice Address - Street 1:11301 WILSHIRE BLVD RM 1225
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-3070
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 383971835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist