Provider Demographics
NPI:1619364205
Name:HAAG, AMBER N (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:N
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 1:1400 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2516
Mailing Address - Country:US
Mailing Address - Phone:620-342-1242
Mailing Address - Fax:620-342-1243
Practice Address - Street 1:1400 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2516
Practice Address - Country:US
Practice Address - Phone:620-342-1242
Practice Address - Fax:620-342-1243
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist