Provider Demographics
NPI:1588900351
Name:HAGEMAN, ALLYSON KAYE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:KAYE
Last Name:HAGEMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:KAYE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2221
Mailing Address - Country:US
Mailing Address - Phone:812-882-1367
Mailing Address - Fax:
Practice Address - Street 1:505 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2221
Practice Address - Country:US
Practice Address - Phone:812-882-1367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-22
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024819A183500000X
HIPH-3415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist