# HAGGEN OPCO NORTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Haggen Pharmacy \#2074
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366499824
- **Authorized official:** GAETANO DIPASQUA (CORPORATE SENIOR VICE PRESIDENT, PH)
- **Authorized official phone:** (360) 650-8204

## Contact information

- **Practice address:** 14300 SW BARROW RD, TIGARD, OR 97223
- **Practice address phone:** (503) 590-4697
- **Practice address fax:** (503) 590-3804
- **Mailing address:** 2211 RIMLAND DR, STE 300, BELLINGHAM, WA 98226-5664
- **Mailing address phone:** (360) 733-8720
- **Mailing address fax:** (360) 752-6437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 0001617 | OR | Yes |

## Other

- **Enumeration date:** 05/30/2006
- **Last updated:** 04/07/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2151119 | PK | — |