Provider Demographics
NPI:1467774455
Name:HAAG, CHERYL MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:MARIE
Last Name:HAAG
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 1:8634 SISSON HWY
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-9556
Mailing Address - Country:US
Mailing Address - Phone:716-992-2407
Mailing Address - Fax:
Practice Address - Street 1:317 S CASCADE DR
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-9108
Practice Address - Country:US
Practice Address - Phone:716-592-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist