Individual
JAYME HAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
520 MAIN ST, WALSENBURG, CO 81089-2036
(719) 738-1130
Mailing address
520 MAIN ST, WALSENBURG, CO 81089-2036
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
11632
NE
183500000X
Pharmacist
Primary
16120
CO
183500000X
Pharmacist
RP00007812
NM
Other
Enumeration date
10/20/2012
Last updated
04/02/2020
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