Healthcare Provider Details

I. General information

NPI: 1104033547
Provider Name (Legal Business Name): ANNIE M HEGG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MAPLE ST ATTN: PHARMACY
WACONIA MN
55387-1752
US

IV. Provider business mailing address

3110 N CHESTNUT ST UNIT 490
CHASKA MN
55318-4593
US

V. Phone/Fax

Practice location:
  • Phone: 952-442-2191
  • Fax: 952-442-6533
Mailing address:
  • Phone: 507-828-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number118533
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5461
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: