Healthcare Provider Details

I. General information

NPI: 1457977373
Provider Name (Legal Business Name): ROBERT JAMES HAIGHT PHARMD, BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 4TH ST NW
FARIBAULT MN
55021-5089
US

IV. Provider business mailing address

400 4TH ST NW
FARIBAULT MN
55021-5089
US

V. Phone/Fax

Practice location:
  • Phone: 507-384-6839
  • Fax:
Mailing address:
  • Phone: 507-384-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number116550
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: