Provider Demographics
NPI:1467970251
Name:HAGG, JENNIFER TRUONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TRUONG
Last Name:HAGG
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 1:20750 E TARA SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BLACK CANYON CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85324-7204
Mailing Address - Country:US
Mailing Address - Phone:417-396-0418
Mailing Address - Fax:
Practice Address - Street 1:6611 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3607
Practice Address - Country:US
Practice Address - Phone:623-334-2973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist