Provider Demographics
NPI:1467733428
Name:HAGGERTY, DOUGLAS BERNARD
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BERNARD
Last Name:HAGGERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N PINE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5584
Mailing Address - Country:US
Mailing Address - Phone:410-322-4276
Mailing Address - Fax:
Practice Address - Street 1:3005 EMMORTON RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2023
Practice Address - Country:US
Practice Address - Phone:410-569-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist