Provider Demographics
NPI:1780569822
Name:HAGAN, EDWARD YAW (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:YAW
Last Name:HAGAN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N HANCOCK ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-1652
Mailing Address - Country:US
Mailing Address - Phone:770-366-7150
Mailing Address - Fax:
Practice Address - Street 1:3780 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-2108
Practice Address - Country:US
Practice Address - Phone:215-508-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP459324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist