NPIMap

Organization Active NPI

Haggen Opco North LLC

Doing business as Haggen Pharmacy #2102

  • Community/Retail Pharmacy
  • Grants Pass, OR
National Provider Identifier
1063468064
Registry record updated Jun 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0002020 Issued in OR
Legal business name
HAGGEN OPCO NORTH LLC
Doing business as
Haggen Pharmacy #2102
Practice address
1690 SW Allen Creek Rd
Grants Pass, OR 97527-5559
Phone
(541) 471-9043
Fax
(541) 471-9047
NPI assigned
May 25, 2006
Last updated
Jun 10, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gaetano Dipasqua
Title
Corporate Senior Vice President, PH
Phone
(360) 650-8204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 0002020 OR Primary

Addresses

Primary practice location

1690 SW Allen Creek Rd
Grants Pass, OR 97527-5559

Mailing address

2211 Rimland Dr
Ste 300
Bellingham, WA 98226-5664
Phone (360) 733-8720

Other identifiers 1

IdentifierTypeStateIssuer
2151958OtherPK

Other names 1

  • Haggen Pharmacy #2102 Doing business as

National Provider Directory

National Provider Directory

Member of 7

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1690 SW Allen Creek Rd
Grants Pass, OR 97527
Phone (541) 471-7085

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1063468064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 RIMLAND DR",
            "address_2": "STE 300",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982265664",
            "telephone_number": "360-733-8720",
            "fax_number": "360-752-6437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 SW ALLEN CREEK RD",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275559",
            "telephone_number": "541-471-9043",
            "fax_number": "541-471-9047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAGGEN OPCO NORTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "DIPASQUA",
        "authorized_official_first_name": "GAETANO",
        "authorized_official_title_or_position": "CORPORATE SENIOR VICE PRESIDENT, PH",
        "authorized_official_telephone_number": "360-650-8204"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "0002020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2151958",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haggen Pharmacy #2102",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.