Provider Demographics
NPI:1497187249
Name:HAGIE, ROBERT L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:HAGIE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 COUNTY ROAD 42 W
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6200
Mailing Address - Country:US
Mailing Address - Phone:952-892-6262
Mailing Address - Fax:
Practice Address - Street 1:1750 COUNTY ROAD 42 W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6200
Practice Address - Country:US
Practice Address - Phone:952-892-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist