Active NPI
Patrick S Hogan, RPH
- Pharmacist
- Dulce, NM
National Provider Identifier
1881642296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 30013
- Practice address
- 12000 Stone Lake Road
Jicarilla Service Unit
Dulce, NM 87528 - Phone
- (575) 759-7250
- Fax
- (575) 759-7288
- NPI assigned
- May 5, 2006
- Last updated
- May 29, 2008
- 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 | 30013 | MO | Primary |
Addresses
Primary practice location
12000 Stone Lake Road
Jicarilla Service Unit
Dulce, NM 87528
Mailing address
HC 75 BX 66
Chama, NM 87520
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000K3526 | Medicaid | NM | |
| HSZ196 | Other | NM | MEDICARE PART B |
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 |
|---|---|---|---|
| 30013 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212019200000",
"number": "1881642296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HC 75 BX 66",
"city": "CHAMA",
"state": "NM",
"postal_code": "87520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12000 STONE LAKE ROAD",
"address_2": "JICARILLA SERVICE UNIT",
"city": "DULCE",
"state": "NM",
"postal_code": "87528",
"telephone_number": "575-759-7250",
"fax_number": "575-759-7288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOGAN",
"first_name": "PATRICK",
"middle_name": "S",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2008-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "30013",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000K3526",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "HSZ196",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dulce, NM
- Michael W Goldberg, M.A.
- Yolandra Gomez, MD
- Sharon Hope Greacen, MT(ASCP)
- Steven Paul Gross, M.D.
- Daniel Xethan Haire, DO
- Diane P Holzem, RN,C
- Indian Health Service- Jicarilla Service Unit
- Deanna S Iovine, RN
- Jicarilla Apache Health Care Facility
- Jicarilla Apache Nation (Jicarilla Behavioral Health)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.