Provider Demographics
NPI:1427861418
Name:HAGAN, VICTORIA M (PHARMD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:HAGAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 AT SMITH RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7231
Mailing Address - Country:US
Mailing Address - Phone:731-225-1219
Mailing Address - Fax:
Practice Address - Street 1:1500 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3212
Practice Address - Country:US
Practice Address - Phone:901-475-6300
Practice Address - Fax:901-475-1888
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist