Provider Demographics
NPI:1912123019
Name:VANDERHAGEN, BARBARA ANN (CPHT)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN
Last Name:VANDERHAGEN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37251 CHARTER OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2412
Mailing Address - Country:US
Mailing Address - Phone:586-247-2997
Mailing Address - Fax:586-247-2983
Practice Address - Street 1:14500 HALL RD
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1229
Practice Address - Country:US
Practice Address - Phone:586-247-2997
Practice Address - Fax:586-247-2983
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI090102258016179183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician