Provider Demographics
NPI:1083602809
Name:HASELOW, PEGGY SUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUE
Last Name:HASELOW
Suffix:
Gender:F
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:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:BEAVER BAY
Mailing Address - State:MN
Mailing Address - Zip Code:55601-0442
Mailing Address - Country:US
Mailing Address - Phone:218-226-4905
Mailing Address - Fax:
Practice Address - Street 1:211 W 4TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-2719
Practice Address - Country:US
Practice Address - Phone:218-726-1370
Practice Address - Fax:218-726-0501
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116852-7183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist