Healthcare Provider Details

I. General information

NPI: 1083602809
Provider Name (Legal Business Name): PEGGY SUE HASELOW PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W 4TH ST
DULUTH MN
55806-2719
US

IV. Provider business mailing address

PO BOX 442
BEAVER BAY MN
55601-0442
US

V. Phone/Fax

Practice location:
  • Phone: 218-726-1370
  • Fax: 218-726-0501
Mailing address:
  • Phone: 218-226-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number116852-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: