Provider Demographics
NPI:1548546096
Name:KAGAN, NANCY LYNN (RPH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:KAGAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-4926
Mailing Address - Country:US
Mailing Address - Phone:218-331-2668
Mailing Address - Fax:218-331-2674
Practice Address - Street 1:700 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4926
Practice Address - Country:US
Practice Address - Phone:218-331-2668
Practice Address - Fax:218-331-2674
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115035183500000X
AZS009996183500000X
IA17989183500000X
ND4395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist