NPI 1568139384

Traci Hagen

Practitioner Pharmacy Technician Modesto, CA

Practice location

Address: 1707 McHenry Ave, Modesto, CA 95350-4352
Phone: (209) 526-4773

Registered specialties

Pharmacy Technician Primary

Pharmacy Service Providers Taxonomy 183700000X Licence 1607371 (CA)

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Registry record

NPI: 1568139384
Entity type: Individual
Sex (as registered): Female
NPI issued: 28 Aug 2021
Record last updated: 28 Aug 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.