Provider Demographics
NPI:1073125803
Name:ENGGAARD, THOR BAGGE (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOR
Middle Name:BAGGE
Last Name:ENGGAARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1623
Mailing Address - Country:US
Mailing Address - Phone:594-240-4235
Mailing Address - Fax:
Practice Address - Street 1:6017 N PALM AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1623
Practice Address - Country:US
Practice Address - Phone:559-424-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist