Provider Demographics
NPI:1518585488
Name:HERZOG, HAYLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:HERZOG
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 1:1260 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2839
Mailing Address - Country:US
Mailing Address - Phone:269-983-0315
Mailing Address - Fax:
Practice Address - Street 1:1260 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2839
Practice Address - Country:US
Practice Address - Phone:269-983-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist