Provider Demographics
NPI:1053344390
Name:HAGGEN, INC
Entity type:Organization
Organization Name:HAGGEN, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PHAR
Authorized Official - Prefix:MR
Authorized Official - First Name:GAETANO (GUY)
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DIPASQUA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-650-8204
Mailing Address - Street 1:2211 RIMLAND DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-733-8720
Mailing Address - Fax:360-752-6437
Practice Address - Street 1:26603 72ND AVE NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6273
Practice Address - Country:US
Practice Address - Phone:360-629-5520
Practice Address - Fax:360-629-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5059333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4924139OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WA6014914Medicaid
WA0471030021Medicare NSC