Healthcare Provider Details

I. General information

NPI: 1578991238
Provider Name (Legal Business Name): ALLIE KAIGLE PHARMD, BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FEDERAL DR
FORT SNELLING MN
55111-4080
US

IV. Provider business mailing address

1 FEDERAL DR
FORT SNELLING MN
55111-4080
US

V. Phone/Fax

Practice location:
  • Phone: 909-787-4814
  • Fax:
Mailing address:
  • Phone: 909-787-4814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPH234935
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234935
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: