Active NPI
Dan John Hagen, RPH
- Pharmacist
- Forest Lake, MN
National Provider Identifier
1609216019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 113270
- Practice address
- 808 Lake St S
Forest Lake, MN 55025-2614 - Phone
- (651) 464-5518
- Fax
- (651) 464-1513
- NPI assigned
- Jun 29, 2013
- Sex
- Male
- Sole proprietor
- No
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 | 113270 | MN | Primary |
Addresses
Primary practice location
808 Lake St S
Forest Lake, MN 55025-2614
Mailing address
808 Lake St S
Forest Lake, MN 55025-2614
Phone (651) 464-5518
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113270 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrifty Drug Stores Inc | Past | Accepting new patients | |
| Lakes Snyder Drug, Inc | 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.
-
- Community/Retail Pharmacy
- Forest Lake, MN
- NPI 1497838759
-
- Community/Retail Pharmacy
- Wadena, MN
- NPI 1710678545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372464000000",
"number": "1609216019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "808 LAKE ST S",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550252614",
"telephone_number": "651-464-5518",
"fax_number": "651-464-1513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "808 LAKE ST S",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550252614",
"telephone_number": "651-464-5518",
"fax_number": "651-464-1513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGEN",
"first_name": "DAN",
"middle_name": "JOHN",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-29",
"last_updated": "2013-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "113270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.