Active NPI
Tiffany M O'Hagan, PHARM D.
- Pharmacist
- Fond Du Lac, WI
National Provider Identifier
1134569585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17039-40
- Practice address
- 192 N Main St
Fond Du Lac, WI 54935-3462 - Phone
- (920) 921-5264
- NPI assigned
- Jun 30, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17039-40 | WI | Primary |
Addresses
Primary practice location
192 N Main St
Fond Du Lac, WI 54935-3462
Mailing address
950 S Koeller St
Oshkosh, WI 54902-6175
Phone (920) 303-1712
Other names 1
- Tiffany M Potratz
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17039-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Fond Du Lac, WI
- NPI 1649285537
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- Pharmacy
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671408000000",
"number": "1134569585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 S KOELLER ST",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549026175",
"telephone_number": "920-303-1712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "192 N MAIN ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353462",
"telephone_number": "920-921-5264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'HAGAN",
"first_name": "TIFFANY",
"middle_name": "M",
"credential": "PHARM D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-30",
"last_updated": "2022-12-19",
"certification_date": "2022-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "17039-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TIFFANY",
"last_name": "POTRATZ",
"middle_name": "M",
"credential": "PHARM D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.