Provider Demographics
NPI:1104033547
Name:HEGG, ANNIE M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:M
Last Name:HEGG
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 1:3110 N CHESTNUT ST UNIT 490
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-4593
Mailing Address - Country:US
Mailing Address - Phone:507-828-4882
Mailing Address - Fax:
Practice Address - Street 1:500 S MAPLE ST
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1752
Practice Address - Country:US
Practice Address - Phone:952-442-2191
Practice Address - Fax:952-442-6533
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118533183500000X
SD5461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist